A case of congenital syphilis
- PDF / 135,549 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 30 Downloads / 182 Views
CASE REPORT
A case of congenital syphilis Lorenzo Mannelli & Francisco A. Perez & Marguerite T. Parisi & Lorenzo Giacani
Received: 4 February 2013 / Accepted: 13 February 2013 / Published online: 27 February 2013 # Am Soc Emergency Radiol 2013
Keywords Congenital syphilis . Wimberger’s sign . Radiolucency . Erosions
first to describe the highly specific radiological osseous changes in congenital syphilis in 1901, and Wimberger described the typical destructive changes of the medial proximal tibia in 1925. Emergency radiologists may be challenged with kind of diseases which are not typical for their common practice. The purpose of this case report is to review X-ray appearance of bone involvement in early congenital syphilis at the time of presentation and at subsequent follow-up.
Introduction
Case report
Although the incidence of syphilis has significantly decreased after the introduction of penicillin, there is a resurgence of syphilis in North America [1, 2] and congenital syphilis remains a problem [3, 4]. Congenital syphilis, an in utero infection which typically manifests shortly after birth [5], is seldom seen in North America, and in some hospitals, routine prenatal serological tests have been discontinued [6]. Radiology plays an important role in the early diagnosis of congenital syphilis as the clinical signs and symptoms may simulate many other conditions in the pediatric age group [7, 8]. The skeletal manifestations were reported in detail by George Wegner in 1870 who considered syphilitic osteochondritis as both inflammatory and destructive in nature. Carl Hochsinger was the
An asymptomatic 3-month-old girl presented to the emergency department with concern for congenital syphilis because her father was recently diagnosed with primary syphilis and her mother was diagnosed with asymptomatic syphilis. Radiographs of the lower limbs demonstrate mild diffuse periosteal reaction involving the femur, tibia, and fibula (Fig. 1). Bilaterally symmetric lucencies and erosions of the medial proximal tibial metaphysis (Wimberger’s sign), lateral aspect of the proximal tibial metaphysis, and medial distal tibial metaphysis are well demonstrated (Fig. 1). The differential diagnosis for multiple bone erosions includes Ewing’s sarcoma, osteoblastoma, metastasis, rheumatoid arthritis, and infection. The patient was diagnosed with congenital syphilis and neurosyphilis based on serological and CSF evaluation and treated with penicillin. Follow-up radiographs obtained 8 months later demonstrate resolution of lucencies, erosions, and periosteal reaction (Fig. 2). Radiographic features along with clinical and biochemical findings were consistent with excellent recovery in this patient with normal interval neurological development, normal hearing, normal vision, no rhinorrhea, and no Hutchinson’s teeth.
Abstract We report a case of an asymptomatic 3-month-old girl presenting to the emergency department with concern for congenital syphilis. Radiographs of the lower limbs demonstrate mild diffuse periosteal reaction invo
Data Loading...
