MSK for Wednesday, April 9th, 2025

History

Newborn infant - mother has concerning lab results and limited prenatal care.

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Question

What congenital condition does this newborn have?

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Correct answer

syphilis

Discussion

This is a case of congenital syphilis showing metaphyseal lucent bands and some fraying and cupping of of metaphyses.  Note the lucent band along the scapular margin, a metaphyseal equivalent.  Mother was seropositive for Treponema pallidum.  Transmission of Treponema pallidum from the mother to her fetus in utero is called vertical transmission and infants can have varied presentations and severity of illness.  Other skeletal findings include periosteal reaction and Wimberger corner sign.  In addition to skeletal findings, infants may have hepatosplenomegaly, rhinitis "snuffles", rash, and decreased movement in affected extremities.  There is currently a marked rise in syphilis infection in the USA, often among asymptomatic mothers.  Screening bloodwork is finding higher rates of syphilis than of gonorrhea or chlamydia (see table).

Differential diagnosis

Herpes and Toxoplasmosis infections do not typically have skeletal manifestations in the newborn period.  Herpes in the newborn tends to cause diffuse cerebritis, rather than the temporal lobe distribution seen in older patients.  Toxo, CMV, HIV, Zika, & rubella all may cause brain parenchymal calcifications; syphilis typically does not.  Rickets is most often due to nutritional deficiency of vitamin D and is not seen until after 3 months of age (unless the mother has profound vit D deficiency).

Additional images

References

• https://my.statdx.com/document/syphilis/2e262809-d1b2-486c-9258-0b89df30dfee?term=Syphilis&searchType=documents&category=All&documentTypeFilters=all https://my.statdx.com/document/torch-infections/3b509e1c-83cf-4793-8307-e0afa70781ce?term=TORCH%20Infections&searchType=documents&category=All&documentTypeFilters=all https://my.statdx.com/document/rickets/85c1b028-1a1b-4ff3-8056-d022c42a954f?term=rickets%20newborn&searchType=documents&category=All&documentTypeFilters=all