Pediatric Syphilis

  • Etiology: transplacental infection by Treponema pallidum spirochete which is disseminated throughout fetus causing symmetrical involvement of enchondral ossification sites
  • Imaging:
    — periostitis of long bones is bilateral, symmetrical, diffuse, mild to severe
    — osteitis – localized to diffuse
    — metaphysis – dense / lucent / alternating, serrations, exuberant callus, Wimberger corner sign of focal proximal tibia is metaphyseal lucency / notch on proximal medial tibial metaphysis due to destruction
  • Clinical:
    — 33% stillborn, 33% contract syphilis, 33% unaffected, may or may not be symptomatic at birth, 66% present at 1-2 months and 100% present by 3 months
    — early congenital syphilis – prematurity, hepatosplenomegaly, jaundice, nasal chondritis (“runny nose”), generalized lymphadenopathy, maculopapular rash
    — late congenital syphilis – saddle nose, sabre shin, frontal bossing, Hutchison’s triad of Hutchison’s teeth / interstitial keratitis / CN VIII deafness

Radiology Cases of Syphilis

Radiograph of osteomyelitis due to syphilis
AP radiograph of the lower extremities shows bilateral diffuse periostitis of the tibiae and some destructive changes on the medial proximal metaphysis of the left tibia (Wimberger’s sign).