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Congenital Syphilis Misdiagnosed as Suspected Nonaccidental Trauma
Kimberley Jacobs1, David M Vu2,3,4, Vidya Mony3
1Lucile Packard Children's Hospital, Palo Alto, California; kjacobs9@stanford.edu.
Insights
Congenital syphilis (CS) is rising, with many infants asymptomatic at birth. A case highlights long bone fractures as an early sign, urging better screening and treatment to prevent this infection.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Congenital syphilis (CS) incidence is at a 20-year high, posing a significant public health concern.
- A substantial proportion of infants with CS are asymptomatic at birth, complicating early diagnosis.
- This highlights potential diagnostic delays and the need for improved prenatal care strategies.
Observation:
- A case study details an infant presenting with recurrent long bone fractures, initially suspected as nonaccidental trauma.
- Further evaluation on subsequent admission revealed a diagnosis of congenital syphilis.
- The presentation underscores that isolated long bone fractures can be an initial manifestation of CS.
Findings:
- Congenital syphilis can present with varied clinical signs, not always apparent at birth.
- Radiographic evidence of long bone fractures may be an early indicator of CS in infants.
- Delayed diagnosis in older infants suggests gaps in current screening and treatment protocols.
Implications:
- Pediatric providers must recognize diverse CS presentations in older infants, including skeletal abnormalities.
- The rising incidence necessitates a reevaluation of universal syphilis screening policies during pregnancy.
- Timely prenatal screening and treatment are crucial for preventing congenital syphilis transmission and its long-term consequences.
Abstract:
Congenital syphilis (CS) is a preventable infection, yet the incidence has surged to the highest rates in 20 years. Because 50% of live-born infants with CS are asymptomatic at birth, there is an increasing likelihood that pediatric providers will encounter older infants whose diagnoses were missed at birth, emphasizing the importance of timely prenatal screening and treatment. We present one such case of an infant admitted twice at 3 and 4 months of age with long bone fractures and suspected nonaccidental trauma. On her second presentation, several additional symptoms prompted evaluation for and eventual diagnosis of CS. In this case, it is demonstrated that an isolated long bone fracture can be a first presentation of CS, with other classic findings possibly appearing later. Pediatric providers should be familiar with the varied presentations of CS in older children, including the radiographic findings that we describe. The rising rates of CS reveal deficiencies in our current strategy to prevent CS and, thus, we recommend reconsideration of universal syphilis screening in the third trimester and at delivery, with timely treatment to prevent CS during pregnancy.
