A 28 year old woman gave birth to a small for age newborn at 38 weeks of pregnancy. On examination, the newborn was found to have rhinitis, distended abdomen; wrinkled skin, and palmoplantar blisters. The woman had an earlier history of abortion and stillbirth. The most likely diagnosis is:
Correct Answer: Congenital syphilis
Description: Ans. (c) Congenital syphilisRef: OP Ghai 8th ed./182y 273Early manifestations of congenital infection vary and involve multiple organ systems.* About 60% of infants born with congenital syphilis are asymptomatic at birth. Symptoms develop within the first 2 months of life. In symptomatic infants, the most common physical finding, reported in almost 100% of cases, is hepatomegaly; biochemical evidence of liver dysfunction is usually observed.* The other common findings are skeletal abnormalities, rash, and generalized lymphadenopathy. Radiographic abnormalities, periostitis or osteitis, involve multiple bones and are seen in the vast majority of symptomatic infants, but they also can be found in a fifth of infants with no symptoms or relevant findings on physical examination. Sometimes, the lesion is painful and an infant will favor an extremity (pseudopalsy).* The rash is maculopapular and may involve palms and soles. In contrast to acquired syphilis, a vesicular rash and bullae may develop. These lesions are also highly contagious.* Mucosal involvement may present as rhinitis ("snuffles"). Nasal secretions are highly contagious.* Hematological abnormalities include anemia and thrombocytopenia. Some infants have leukocytosis. Abnormal CSF examination is seen in a half of symptomatic infants but also can be found in 10% of those who are asymptomatic.* Late-onset congenital syphilis (diagnosed >2 y)* Scarring from the early systemic disease causes late manifestations of congenital syphilis. Manifestations include neurosyphilis and involvement of the teeth, bones, eyes, and the eighth cranial nerve, as follows:# Bone involvement - Saber shins, saddle nose# Teeth involvement - Notched, peg-shaped incisors (Hutchinson teeth)# Pigmentary involvement - Linear scars (rhagades) at the corners of the mouth# Interstitial keratitis - Presents in the first or second decade of life# Sensory-neural hearing loss (eighth cranial nerve deafness) - Presents between age 10 and 40 years.# Classic Hutchinson triad - (1) defective incisors, (2) interstitial keratitis, (3) eighth cranial nerve deafness.
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