Late congenital syphilis

Case contributed by Dr Komal Kritika Singh

Presentation

Bilateral shin pain and swelling.

Patient Data

Age: 4 years
Gender: Male
X-ray

Right leg (AP/lateral): there is cortical thickening with periosteal reaction of the right tibial shaft. Two ovoid lucencies are seen with the thickened cortex of the tibia. There is associated soft tissue swelling of the right shin.

Left leg (AP/lateral): there is cortical thickening of both tibial and fibular shafts.

Case Discussion

Late congenital syphilis by definition occurs in children more than 2 years old, where the infection was initially transmitted transplacentally. It is also known as the latent presentation of congenital syphilis. One of the symptoms is "Saber shins" which are due to chronic osteitis and associated soft tissue reactive changes. 

Other symptoms include:

  • Hutchinson triad which includes:
    • Hutchinson's teeth: smaller, wider placed incisors with notches
    • degrees of blindness due to interstitial keratitis
    • deafness from auditory nerve disease
  • prominent brow bridge frontal bossing
  • hard palate defect
  • short maxillae and protruding mandible
  • saber shins and swollen knees
  • saddle nose

In this patient, the venereal disease research laboratory (VDRL) titer was positive and the patient was treated with penicillin.

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Case information

rID: 70309
Published: 3rd Oct 2019
Last edited: 3rd Oct 2019
Inclusion in quiz mode: Included

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