Congenital Syphilis Misdiagnosed as Suspected Nonaccidental Trauma

Abstract

Drs Jacobs and Buzi drafted and revised the manuscript; Drs Vu, Mony, and Sofos provided further critical review and revisions; and all authors cared for this patient, approve the final manuscript as submitted, and agree to be accountable for all aspects of the work.

A Lucky Break: A Case of a 3-Month-Old Female With a Pathologic Fracture

“…5,9 With the increasing incidence of syphilis, pediatric providers need a heightened suspicion for CS after the neonatal period, and to be aware of presenting symptoms, radiologic findings, and laboratory testing. 11…”

“…These skeletal manifestations may be associated with pain, decreased range of motion, and fractures. 11 Radiographic abnormalities are typically metaphyseal and symmetric, including the long bones (femur, tibia, and humerus), ribs, and skull. Although uncommon, the previously described Wimberger sign (Figure 1) is strong indicator of CS.…”

“…Additionally, syphilitic periosteal changes may be misinterpreted as a normal variant in infants. 11 Atypical radiologic appearances are common, so pediatric providers should be familiar with these radiologic findings, maintain a broad differential diagnosis, and collaborate closely with radiologists. 2,11…”

“…Primary prevention of CS is via maternal screening for syphilis, yet this screening is limited by access to care, periodicity of screening, and false negatives. 9,11,16 Maternal syphilis is treated with benzathine penicillin G. 3,16 The suspected duration of infection informs the number of doses required. Optimal infant outcomes occur with early initiation of treatment and may prevent up to 98% of CS cases.…”

“…Optimal infant outcomes occur with early initiation of treatment and may prevent up to 98% of CS cases. 3,11…”