Congenital Syphilis

A preterm male infant born at 31 weeks’ gestation via cesarean section for fetal distress was noted to have hepatomegaly on day 1 of life, without rash, lymphadenopathy, or splenomegaly. Lab results showed thrombocytopenia and elevated alkaline phosphatase. Imaging confirmed liver enlargement. RPR was 1:128, and both fluorescent treponemal-antibody absorption and PCR assays (CSF, nasal secretions) were positive for Treponema pallidum. Radiographs revealed periostitis, celery stalk appearance, and Wimberger sign. The asymptomatic mother (RPR 1:128) had not received syphilis screening during prenatal care. Infant was treated with IV benzylpenicillin, and mother with IM benzathine penicillin G. At 6-month follow-up, the infant was developmentally normal.

A preterm male infant born at 31 weeks’ gestation via cesarean section for fetal distress was noted to have hepatomegaly on day 1 of life, without rash, lymphadenopathy, or splenomegaly. Lab results showed thrombocytopenia and elevated alkaline phosphatase. Imaging confirmed liver enlargement. RPR was 1:128, and both fluorescent treponemal-antibody absorption and PCR assays (CSF, nasal secretions) were positive for Treponema pallidum. Radiographs revealed periostitis, celery stalk appearance, and Wimberger sign. The asymptomatic mother (RPR 1:128) had not received syphilis screening during prenatal care. Infant was treated with IV benzylpenicillin, and mother with IM benzathine penicillin G. At 6-month follow-up, the infant was developmentally normal.