6 Week Old Baby with Skin Rash and Bilateral Bone Abnormalities • Xray of the Week
What is the diagnosis?
Figure 1. Radiographs of the upper and lower extremities. Clinical images of the hand and foot. What is the diagnosis? Clinical images courtesy of Peter Koetters, MD.
Figure 2. Annotated radiographs of the upper and lower extremities. There is diffuse mild periostitis of the long bones (red arrows). Mild irregularity of the distal femoral and proximal tibial metaphyses is also present (green arrows). There is mild sclerosis and cupping of the distal radial and ulnar metaphyses as well as the proximal fibular metaphysis (yellow arrows). A rash on the hands and soles with associated with desquamation is another clue to the diagnosis. Clinical images courtesy of Peter Koetters, MD.
Discussion: Congenital syphilis is still a major problem in sub-Saharan Africa, but there is a resurgence in several European countries and in North America. Congenital syphilis occurs when Treponema pallidum crosses the placenta during birth or by contact with an infectious lesion. Mucocutaneous involvement is present in about 70% of infants with early congenital syphilis. It is typically a vesicular or maculopapular rash occurring on the palms and soles. As seen in this case, it may be associated with desquamation. The musculoskeletal anomalies include periostitis, metaphysitis, sawtooth metaphysis, diaphyseal osteomyelitis, pathological fractures, joint effusions, sabre shin, dactylitis, and several craniofacial anomalies.
Treatment is with benzathine penicillin G, and prognosis is usually good unless non-reversible changes have occured.
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Kellie Greenblatt, MD
Pediatric Radiologist, RIMA
A native of the Bay Area, Dr. Greenblatt attended the University of California at Berkeley where she earned a BA in Human Biodynamics. Following graduation, Dr. Greenblatt performed basic research for four years in the toxicology laboratory at Lawrence Livermore Laboratory focusing on carcinogens found naturally in cooked meat. Following her work at Lawrence Livermore, Dr. Greenblatt attended medical school at the Chicago Medical School. After medical school, Dr. Greenblatt did two years of residency training in Surgery before entering a Diagnostic Radiology residency. She completed her Radiology Residency at Kaiser Permanente in Los Angeles, California, then did a one year fellowship in Pediatric Radiology at Children’s Hospital Los Angeles.
Kevin M. Rice, MD is president of Global Radiology CME and serves as the Chief of staff and Chair of the Radiology Department of Valley Presbyterian Hospital in Los Angeles, California and is a radiologist with Renaissance Imaging Medical Associates. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. Dr. Rice co-founded Global Radiology CME with Natalie Rice to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" Award for the Most Effective Radiology Educator.
Follow Dr. Rice on Twitter @KevinRiceMD