Congenital syphilis

Case contributed by Dr. Roy Waknin

Presentation

A baby girl at 36 weeks gestational age was delivered via c-section.

Patient Data

Age: 8 days
Gender: Female
X-ray

Both upper extremities: There is periostitis involving the diaphysis and metaphysis of both humeri, radii and ulnae. There is also lucency along the metaphyseal region. This constellation of findings is consistent with the provided history of congenital syphilis. There is no evidence of pathologic fracture.

Both lower extremities: The examination is limited as no true AP view was performed secondary to patient positioning. There is periostitis involving the diaphysis and metaphysis of both femurs, tibias and fibulas. There is lucency along the metaphysis consistent with the provided history of congenital syphilis. Detailed evaluation of the tibial metaphysis is limited secondary to patient positioning. Therefore, the presence of erosions along the proximal tibia (Wimberger sign) cannot be assessed. There is no evidence of pathologic fracture.

Case Discussion

This baby girl was born premature at 36 weeks gestation via non-emergent c-section. In the delivery room, she presented with decreased tone, respiratory distress, and desaturation.

The patient's mother has a past medical history of psychosis and substance abuse. She did not seek prenatal care for her current pregnancy. Before delivery, she was rapid plasma reagin (RPR) test reactive and had positive titers of Treponema pallidum antibodies (TP-A) at 1:128.

Osseous findings of the baby girl at 8 days are consistent with the provided history of in utero syphilis infection, or congenital syphilis.

The baby was treated with Penicillin G.

This case was submitted with supervision and input from:

Soni C. Chawla, M.D.                                                                                                
Associate Professor                                       
Department of Radiological Sciences                      
David Geffen School of medicine at UCLA               
Olive View-UCLA Medical Center

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