Age / Sex : 55 / F

Age / Sex: 3 months/ Male

Chief complaint : A sudden limitation of left arm movement (4 days ago)

congenital syphillis

Discussion

Findings:

1)      Both upper extremity AP & lateral views:

1.        Left  humerus shows periosteal reaction (periostitis) in the mid to distal shaft and  ill defined osteolytic lesion with  pathologic fracture in the distal metaphysis.

2.       Right humerus shows periosteal reaction (periostitis) in the mid to distal shaft.

3.       Ill defined osteolytic lesion is seen in the right distal ulnar metaphysis.

2)       Bone scan:

Hot uptake is noted in the left distal humerus.

Differential Diagnosis:
         1. Syphilis with periostitis, (lucent metaphyseal line 이 definite 하지 않으나  clinical correlation 필요).
         2. Battered child syndrome ( Child abuse )
         3. OM
         4. Metabolic disorder
                    

Diagnosis:  Congenital syphilis

Discussion:
 Osteoarticular manifestations of syphilis wre recognized since the beginning of the 20^th centrury and can be seen with congenital, secondary, the tertiary syphilis.  Musculoskeletal manifestations of congenital syphilis in fetuses, neonates, and very young children include osteochondritis (irregular epiphyseal line, subchondral metaphyseal radiolucent bands, diaphyseal cupping, metaphyseal erosion at the growth plate junction, and periosteal thickening), diaphyseal osteomyelitis (osteitis), periostitis, and miscellaneous changes. Musculoskeletal manifestations of secondary syphilis are nonspecific. The diagnosis is usually suspected because of association with mucocutaneuous findings., including an erythematous maculopapular rash involving the palms and soles, mucosal patches, condylomata lata, and generalized lymphadenopathy. Musculoskeletal manifestations of tertiary syphilis are rare, and the neuropathic or Charcot joint is the most characteristic fiding. Gummatous involvement of the joints is an unusual manifestation.

Reference :  
Imaging of the Musculoskeletal System ( Expert Radiology), Saunders, 2008, 1^st Edt. P 1394-1403