The “Great Imitator’’-Congenital Syphillis

Abstract

Background: Most antenatal centers have stopped routine screening for syphilis; it is assumed that the advent of penicillin had eradicated the disease. Cases of congenital syphilis seen in neonates and diagnosed by radiological features before serological confirmation were reviewed. Results: Twenty neonates presented for peripheral limbs radiographs within the studied period. Ten of them had positive radiographic features with serological confirmation. None of the mothers had VDRL screening in pregnancy. Periarticular swelling (of the knee) was the commonest presentation and Metaphysitis (ostechondritis) characterized by “saw tooth” distal metaphysis and periostitis were the commonest features. Conclusion: High index of suspicion and awareness of congenital syphilis are required to avoid misdiagnosis by clinicians and radiologists. Routine prenatal screening should be instituted by all antenatal care providers to prevent congenital syphilis since some cases are not symptomatic until late stage.

Keywords

• congenital syphillis antenatal screening metaphysitis periostitis