Pseudoparalysis paradox: Think of 'SCORTCH'

There is recent resurgence in incidence of congenital syphilis (CS) in developing and developed countries. Diagnosis of CS can be difficult because approximately two-thirds infants affected are asymptomatic at birth. Pseudoparalysis due to bony pain is often not a sign but symptom, obvious not only to healthcare providers but also parents. We report a case of CS, observed to have excessive crying episodes on handling with no obvious changes on radiograph. Evaluation with 'SCORTCH' profile clinched the diagnosis. Neonate was treated with ceftriaxone due to non-availability of crystalline or procaine penicillin with good outcome at 1year of age.