Third generation infantile syphilis--an unusual presentation.

A case of third generation early congenital syphilis with unusual features is reported and discussed. The infant presented with Livedo reticularis and an ulcer on the right forearm since birth; the underlying radius and ulna showed osteomyelitic changes with sequestrum formation and a pathological fracture. The rest of the skeletal system was normal. The blood STS (VDRL) was reactive at 1:64. The child showed no other evidence of congenital syphilis. Livedo reticularis and bony lesions resolved promptly with penicillin therapy, but abnormal movements at the wrist joint persisted. The mother had pathognomic Hutchinsonian incisors and a reactive VDRL test.