The following is the summary of “Congenital syphilis as the cause of multiple bone fractures in a young infant case report” published in the December 2022 issue of Pediatrics by  Koliou, et al.

When a young newborn presents with multiple, unexplained bone fractures, child maltreatment and bone diseases like osteogenesis imperfecta are common suspects in the diagnostic process. Bone abnormalities may be the only symptom of congenital syphilis in as many as 60% to 80% of cases. This common symptom of a rare condition like congenital syphilis is often overlooked, though. In this article, researchers present the case of a young infant diagnosed with congenital syphilis after suffering many lengthy bone fractures. The fractures of the ulna and distal radius on both sides, as well as the noisy breathing, led to the referral of this 2-month-old male patient with the suspected diagnosis of osteogenesis imperfecta to their hospital. 

A thorough physical examination revealed that the infant had anemia and a palpable spleen. Investigators also did other tests to look for congenital infections, and we found that the patient had both non-treponemal and treponemal antibodies for syphilis. As a result, congenital syphilis was identified as the cause. A LP was performed, and it revealed a little pleocytosis. For 10 days, the patient received 200 000 UI/KG of aqueous penicillin G by intravenous infusion. Due to the Cerebrospinal Fluid(CSF) test results, a single dose of intramuscular penicillin G benzathine 50 000 UI/KG was administered.

By the time of the follow-up admission 6 months later, both the new syphilis serology and the new LP had shown significant improvement. As this is a rare condition that must be considered in the differential diagnosis of many unexplained fractures in early infancy, they submitted this case report to remind readers of a common presentation of congenital syphilis. Anemia and mild hepatosplenomegaly followed their  patient’s symmetric and bilateral fractures, prompting us to look into congenital syphilis as a probable cause. Nonetheless, at birth, 2/3 of babies born with congenital syphilis show no signs of the disease. The prevention of syphilis in pregnant women requires that all women be tested for the disease.

Source: bmcpediatr.biomedcentral.com/articles/10.1186/s12887-022-03789-y