Unusual early skeletal manifestations in a neonate with congenital syphilis

CASE REPORTS

Unusual early skeletal manifestations in a neonate with congenital syphilis

Tehsin Patel, Sruthi Nair, Prashanth RR, Anitha Haribalakrishna.

Department of Neonatology, Seth G.S. Medical College and King Edward Memorial Hospital, Mumbai, India.

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Abstract
Congenital syphilis is a preventable infection caused by Treponema Pallidum usually involving multiple system. We report a case of a neonate born to mother with latent syphilis, presenting with bone changes on radiography without any clinical signs or symptoms of congenital syphilis. In this case, it is demonstrated that isolated long bone fractures can be the initial presenting sign of congenital syphilis with other classical findings possibly appearing later and early treatment for the same. We have highlighted the importance of radiological survey in asymptomatic neonates with positive serology.

Why this article important?

Congenital syphilis presenting with metaphysistis of bilateral long bones such as tibia and femur is a rare manifestation of congenital syphilis. Clavicular fracture is a common birth injury however in the presence of bony changes of syphilis requires to be relooked especially when there is no significant birth trauma A complete evaluation is a must for better management of congenital syphilis. In resource limited settings there needs to be evaluation of the mother during pregnancy for syphilis and requires treatment to be initiated. In cases of latent syphilis early recognition of neonatal condition prevents long term complications and neonatal morbidities.

Summary of article

Congenital syphilis is a preventable infection caused by Treponema Pallidum usually involving multiorgan involvement. Latent syphilis presenting with metaphysis is a rare manifestation of this disease. We have highlighted the importance of radiological surveys in such asymptomatic neonates with positive serology. We have also highlighted the diagnostic approach and management, especially keeping in mind the financial and diagnostic constraints in resource-limited conditions. Congenital syphilis is an emerging neonatal problem which requires adequate evaluation and diagnosis. Early initiation of treatment in these neonates aids in preventing long-term complications. The testing of mothers for syphilis even though is mandatory needs to be reemphasised during each pregnancy.

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