Simulating Non-accidental Trauma with Worsening Findings: Congenital Syphilis

Abstract

This is a case report of a pediatric patient that presented to the emergency department following an un-witnessed trauma. The patient’s parent’s provided history was inconclusive with suspicion of non-accidental trauma. Review of the radiological images was performed. An initial radiographic skeletal survey was obtained and demonstrated radiographic findings suggestive of non-accidental trauma. The follow-up radiographic skeletal survey demonstrated a worsening of the prior radiographic findings rather than the expected healing in cases of non-accidental trauma. Specifically, the follow-up radiologic imaging demonstrated an abnormal lucency with medial down-sloping of the proximal tibial metaphysis, representing osseous destruction of the cortex with metaphyseal osteolysis, suggesting the possibility of infectious etiologies. Following review of the radiological images, serology was obtained. Serological markers were obtained and demonstrated active syphilis. Although syphilis has specific radiological findings, it can be initially misinterpreted as non-accidental trauma. This case report reviews the clinical picture, including the history, serology, and radiographic correlation and demonstrates the importance of considering alternative etiologies when evaluating the musculoskeletal system in the pediatric population.