Congenital syphilis in Nebraska: a case report.

In the United States, the incidence of acquired syphilis has increased thirty four percent in the last decade with young, black, urban dwelling, drug dependent females representing the highest risk group. Concomitantly, congenital syphilis has increased causing spontaneous abortions, stillbirths, and neonatal morbidity and longterm neurologic sequela. Because physicians are no longer familiar with the disease, it is estimated that only twenty-five percent of neonatal syphilis is diagnosed during the first year of life. This report describes the first reported case of congenital syphilis in Nebraska. Our patient demonstrates the typical clinical findings of lethargy, extremity swelling and the pseudoparalysis of Parot, while laboratory evaluation showed anemia, abnormal hepatic enzymes, hypoproteinemia, and confirmatory positive neonatal VDRL and FTA-ABS. The plain film radiographic survey illustrated the characteristic findings of periostitis, metaphyseal banding and cortical erosion. By relying upon the relatively inexpensive and easy to obtain radiographic long bone survey a prompt diagnosis can be made and immediate treatment instituted while awaiting confirmatory serology. We must reacquaint ourselves with the increasing incidence of acquired and congenital syphilis. This will enable us to make a timely and cost-effective diagnosis of cogenital syphilis and prevent its devastating complications.