Congenital and perinatally acquired infections: Case

This infant has the classic presentation of early congenital syphilis. Blood-tinged nasal discharge (snuffles), a maculopapular rash on the palms and soles, and hepatosplenomegaly form a pathognomonic triad, and the maternal history is the key: a reactive syphilis serology at 34 weeks treated with only a single dose of benzathine penicillin two days before delivery is inadequate to prevent congenital infection, because effective prevention requires treatment completed at least 30 days before delivery. Congenital syphilis is entirely preventable, and this case represents a failure of antenatal access and treatment timing. ^[1]

Clinical findings

The clinical findings reflect widespread spirochaetal dissemination. The nasal discharge is highly infectious. The rash, particularly on the palms and soles, and the hepatosplenomegaly with associated hepatitis and often conjugated hyperbilirubinaemia are typical. Additional findings may include generalized lymphadenopathy, pseudoparalysis of Parrot from painful periostitis and osteochondritis, a Wimberger sign (metaphyseal destruction of the medial proximal tibia), thrombocytopenia, and an anaemia. Long-bone radiographs characteristically show periostitis and osteochondritis. ^[2]