Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
BMC Pediatr. 2024 Oct 9;24(1):639. doi: 10.1186/s12887-024-05105-2.
Congenital syphilis (CS) is a sexually transmitted disease caused by Treponema pallidum (TP). When the skeletal system is involved, it often results in multiple, symmetrical bone destruction at the epiphyses of long tubular bones such as the humerus and radius, rarely involving the calcaneus. This article reports a case of calcaneal osteomyelitis caused by TP in a child with no other bone damage and subtle clinical manifestations, No similar cases have been reported.
A 4-month-old male infant presented with right foot swelling without any obvious cause and no history of trauma. X-ray and CT scans showed bone loss in the calcaneus and surrounding soft tissue swelling. Review of past medical records revealed that the infant had been diagnosed with CS infection during a hospital stay for "pneumonia" at one month old. The parents refused surgery, opting for conservative treatment at an external hospital for three weeks, during which the symptoms of the affected foot showed no significant improvement. Subsequently, the child was treated at our hospital with surgery, including lesion removal and cast fixation, followed by oral antibiotic treatment. The last follow-up showed no swelling or tenderness in the affected foot, with good mobility, and X-rays indicated that the bone had essentially returned to normal.
Early CS rarely involves the calcaneus. When diagnosing unexplained calcaneal osteomyelitis in infants, this rare cause should be considered. A thorough medical history should be taken and a careful physical examination conducted. Once diagnosed, timely surgical debridement and appropriate antibiotic therapy targeting TP infection are required. Early identification and intervention can result in a good prognosis without related complications.
先天性梅毒（CS）是一种由梅毒螺旋体（TP）引起的性传播疾病。当骨骼系统受累时，它常导致长管状骨（如肱骨和桡骨）的骨骺处出现多发性、对称性骨破坏，很少累及跟骨。本文报告了一例由 TP 引起的儿童跟骨骨髓炎病例，该患儿无其他骨骼损伤且临床表现不明显，无类似病例报告。
一名 4 月龄男性婴儿因右脚肿胀就诊，无明显原因，无外伤史。X 线和 CT 扫描显示跟骨和周围软组织肿胀有骨质丢失。回顾既往病历，患儿在 1 个月大时因“肺炎”住院时被诊断为 CS 感染。患儿父母拒绝手术，在一家外院接受了 3 周的保守治疗，但患足症状无明显改善。随后，患儿在我院接受了手术治疗，包括病灶清除和石膏固定，随后口服抗生素治疗。末次随访时患足无肿胀或压痛，活动度良好，X 线显示骨基本恢复正常。
早期 CS 很少累及跟骨。当诊断婴儿不明原因的跟骨骨髓炎时，应考虑这种罕见病因。应详细询问病史并仔细进行体格检查。一旦确诊，需要及时进行手术清创和针对 TP 感染的适当抗生素治疗。早期识别和干预可获得良好的预后，无相关并发症。
