Case report
An Atypical Presentation of Congenital Syphilis with Pseudoparalysis and Nephrotic Syndrome in a 45-day-old Infant: A Case Report
SD01-SD03
Correspondence
MG Ravanagomagan,
G-4, R Block, Sree Balaji Medical College and Hospital (SBMCH),
Chromepet, Chennai-600044, Tamil Nadu, India.
E-mail: drmgr04@gmail.com
Congenital syphilis is a preventable infection transmitted from mother to foetus through the placenta by Treponema pallidum and continues to contribute to considerable neonatal illness and death. The disease can affect multiple organs, including the skin, bones, liver, kidneys, and central nervous system, and may present with diverse and unusual clinical features. Prompt identification is crucial, as delayed diagnosis can result in serious complications even when appropriate treatment is given. A 45-day-old male infant presented with reduced limb movements, irritability, and fever. Examination revealed hepatosplenomegaly, desquamation of palms and soles, and radiographic findings including metaphyseal destruction (Wimberger sign) and ‘celery-stalk’ appearance of the distal femur. The infant subsequently developed congenital nephrotic syndrome. Although the mother’s antenatal Venereal Disease Research Laboratory (VDRL) screening was reported negative, the combination of clinical, radiological, and serological findings established the diagnosis of congenital syphilis. Despite prompt treatment with crystalline penicillin and supportive therapy, the infant succumbed to sepsis during the third week of illness. This case highlights an unusual presentation of congenital syphilis masquerading as neuromuscular weakness, later complicated by nephrosis, emphasising the importance of high clinical suspicion and multidisciplinary evaluation in atypical neonatal presentations.