Abstract
Syphilis is an infection caused by Treponema pallidum spirochetes. The diagnosis of this sexually transmitted disease may be missed, partly due to the painless nature of genital ulcers in its primary stage. Women in Canada are screened for syphilis in their first trimester of pregnancy, but late pregnancy testing is not done in all provinces to date; therefore, undetected vertical transmission of syphilis may occur. This case emphasizes the importance of recognizing congenital syphilis in infants and young children with unexplained growth problems and biochemical and hematological abnormalities. Congenital syphilis remains a rare diagnosis, but in the context of increased syphilis rates in Canada during recent years, clinicians should consider this diagnosis in infants presenting with compatible clinical manifestations.
Highlights
Congenital syphilis can be challenging to diagnose, as it may mimic other conditions
Clinicians may not consider congenital syphilis due to the rarity of this diagnosis and because women are screened for syphilis in first trimester of pregnancy
We report the case of an infant with intrauterine growth restriction (IUGR) and known congenital cytomegalovirus infection who presented with persistent anemia, thrombocytopenia and liver enzyme elevation
Summary
Congenital syphilis can be challenging to diagnose, as it may mimic other conditions. We report the case of an infant with intrauterine growth restriction (IUGR) and known congenital cytomegalovirus infection who presented with persistent anemia, thrombocytopenia and liver enzyme elevation. This case highlights the need to have a high index of suspicion in infants presenting with these findings and raises important questions about the need for third trimester screening in pregnant women in Canada. The anemia and liver enzyme abnormalities were thought to be due to valganciclovir toxicity so treatment was held He was seen in the clinic a week later without improvement of his blood work findings; he was admitted to the Paediatrics ward for further investigation. His mother was referred to an adult infectious diseases clinic, where she received appropriate treatment and serological follow-up
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