Abstract A patient who presented with recurrent bilateral knee effusions was found to have positive serum syphilis serology. [ncbi.nlm.nih.gov]

Here, we report a case of late congenital syphilis presenting as palatal perforation and saddle nose deformity, also fulfilling the Kassowitz law. [ijstd.org]

• Hutchinson's Triad

  A50.51 Clutton's joints A50.52 Hutchinson's teeth A50.53 Hutchinson's triad A50.54 Late congenital cardiovascular syphilis A50.55 Late congenital syphilitic arthropathy A50.56 Late congenital syphilitic osteochondropathy A50.57 Syphilitic saddle nose [icd10coded.com]

  Skin -rhagades(cracks, fissures atmucocutaneousjunctions) #1, 2, & 3 are part of Hutchinson’s triad Extended discussion Epidemiology (Treponema Pallidum): Transmitted at any time during pregnancy or at birth Transmitted at any disease stage Almost 100% [johnsarm.net]

  triad ), such as Hutchinson teeth and perforation of the hard palate interstitial keratitis (part of Hutchinson triad ) neurosyphilis including sensorineural deafness (part of Hutchinson triad ) musculoskeletal anomalies paroxysmal cold hemoglobinuria [radiopaedia.org]

  Hutchinson’s triad (Hutchinson’s teeth, interstitial keratitis, and VIIIth nerve deafness) is considered pathognomonic of late congenital syphilis. [dartmouth.edu]

  Hutchinson's triad, a set of symptoms consisting of deafness, Hutchinson's teeth (centrally notched, widely spaced peg-shaped upper central incisors ), and interstitial keratitis (IK), an inflammation of the cornea which can lead to corneal scarring and [en.wikipedia.org]

• Intermittent Claudication

  claudication intestine intracranial joint joint prosthesis kidney knee laceration lacrimal lower limb lung malignant molar pregnancy multiple muscle Neoplasm nerve newborn nondisplaced nontraumatic obstetrical trauma obstruction organ Osteochondrosis [books.google.com]

• Saddle Nose

  Clinical examination showed the "saddle-nose" deformity, Hutchinson's teeth, high-arched palate, Dubois little-finger sign, and small maxillae resulting in shallow depression of the central part of the face. [ncbi.nlm.nih.gov]

  The saddle nose deformity was due to the failure of development of nasal bones. [ijstd.org]

  A50.51 Clutton's joints A50.52 Hutchinson's teeth A50.53 Hutchinson's triad A50.54 Late congenital cardiovascular syphilis A50.55 Late congenital syphilitic arthropathy A50.56 Late congenital syphilitic osteochondropathy A50.57 Syphilitic saddle nose [icd10coded.com]

  Common late manifestations (appear 2 yrs of age): Teeth -Hutchinson teeth (notched, pegged), mulberry molars Eye -interstitial keratitis Cranial nerves -8th nerve deafness Skeletal -frontal bossing, high arched palate, saddle nose (markedlydepressed bridge [johnsarm.net]

  Similar to Secondary Syphilis in adults Triad Hutchinson Teeth (1 st lower molors) Deafness (8 th Nerve) Interstitial Keratitis Lymphadenopahy Autoimmune Haemolytic anemia Osteochondritis and Metaphysitis Glaucoma Pseudoparalysis of parrot (Painful limbs) Saddle [mediconotebook.com]

• Hutchinson's Teeth

  Clinical examination showed the "saddle-nose" deformity, Hutchinson's teeth, high-arched palate, Dubois little-finger sign, and small maxillae resulting in shallow depression of the central part of the face. [ncbi.nlm.nih.gov]

  A50.51 Clutton's joints A50.52 Hutchinson's teeth A50.53 Hutchinson's triad A50.54 Late congenital cardiovascular syphilis A50.55 Late congenital syphilitic arthropathy A50.56 Late congenital syphilitic osteochondropathy A50.57 Syphilitic saddle nose [icd10coded.com]

  General wasting, enlarged liver, gumma of the frontal bone, Hutchinson’s teeth, gummatous ulcer of palate Stigmata of late congenital syphilis in a boy at age 15 years, year 1943. [pathologylearningcentre.uct.ac.za]

  Hutchinson’s triad (Hutchinson’s teeth, interstitial keratitis, and VIIIth nerve deafness) is considered pathognomonic of late congenital syphilis. [dartmouth.edu]

  Common late manifestations (appear 2 yrs of age): Teeth -Hutchinson teeth (notched, pegged), mulberry molars Eye -interstitial keratitis Cranial nerves -8th nerve deafness Skeletal -frontal bossing, high arched palate, saddle nose (markedlydepressed bridge [johnsarm.net]

• Mulberry Molar

  Common late manifestations (appear 2 yrs of age): Teeth -Hutchinson teeth (notched, pegged), mulberry molars Eye -interstitial keratitis Cranial nerves -8th nerve deafness Skeletal -frontal bossing, high arched palate, saddle nose (markedlydepressed bridge [johnsarm.net]

  The most important signs are frontal bossae (bony prominences of the forehead) (87%), saddle nose (74%), short maxilla (83%), high arched palate (76%), mulberry molars (more than four small cusps on a narrow first lower molar of the second dentition), [dartmouth.edu]

  It can even cause mulberry molars in fetus. Syphilis can result in miscarriages, stillbirths, premature births, or even death of the newborn babies. [hxbenefit.com]

  Late manifestations (age 3 or older) result from scarring during early systemic disease and include Hutchinson teeth, Mulberry molars, abnormal facies, cranial nerve VIII deafness, bony changes such as saber shins and perforations of the hard palate, [aao.org]

• High Arched Palate

  Clinical examination showed the "saddle-nose" deformity, Hutchinson's teeth, high-arched palate, Dubois little-finger sign, and small maxillae resulting in shallow depression of the central part of the face. [ncbi.nlm.nih.gov]

  The most important signs are frontal bossae (bony prominences of the forehead) (87%), saddle nose (74%), short maxilla (83%), high arched palate (76%), mulberry molars (more than four small cusps on a narrow first lower molar of the second dentition), [dartmouth.edu]

  Common late manifestations (appear 2 yrs of age): Teeth -Hutchinson teeth (notched, pegged), mulberry molars Eye -interstitial keratitis Cranial nerves -8th nerve deafness Skeletal -frontal bossing, high arched palate, saddle nose (markedlydepressed bridge [johnsarm.net]

  arched palate, short upper jawbone, nerve deafness and fissuring around the mouth and anus. [rarediseases.org]

  High arched palate 6. “Bull dog jaw” (prominent mandible) 7. “ Sabre tibia” 8. Scaphoid shape of the scapula 9. [slideshare.net]

• Notched Incisors

  Infection of the enamel causes notched incisors (Hutchinson’s teeth). In the liver large areas of parenchymal cells are separated by loose fibrous connective tissue (hepar lobatum). [histopathology-india.net]

  incisors), keratitis and deafness and occurs in 63% of cases. [4] Treatment (with penicillin) before the development of late symptoms is essential. [5] Signs and symptoms [ edit ] abnormal x-rays. [en.wikipedia.org]

  Syphilitic vasculitis can damage developing tooth buds, leading to peg-shaped, notched incisors (Hutchinson teeth) and multicusped first molars (mulberry molars). Deciduous teeth are not affected. [clinicaladvisor.com]

• Keratosis

  Keratosis obturans and external ear canal cholesteatoma: how and why we should distinguish between these conditions. Clinical Otolaryngology and Allied Sciences, Vol. 29, Issue. 6, p. 577. CrossRef Google Scholar Belden, Clifford J. [cambridge.org]

• Corneal Opacity

  Stigmata due to late congenital syphilis are perforation of palate, corneal opacities, optic atrophy and periosteal changes of tibia. [6] The transmission of infection to the fetus can occur at any time, but in most of the cases it occurs in utero. [ijstd.org]

  Eyes revealed dense corneal opacities with complete loss of vision in right eye. Left eye was normal. Patient was edentulous. VDRL test was reactive in dilution and TPHA was positive. Ultra sound showed hepatosplenomegaly with left renal cyst. [ijdvl.com]

• Saber Shin

  shin Bilateral forward bowing of tibia is conclusive evidence for acquired, tertiary syphilis although similar changes can occur with congenital form Acquired syphilis affects skull (mixed sclerosis and lysis) Clavicle and tibia [learningradiology.com]

  The first is a depressed deformity of the bridge of the nose (saddle nose), and the second is anterior bowing of the tibias (saber shins). Infection of the enamel causes notched incisors (Hutchinson’s teeth). [histopathology-india.net]

  Late manifestations (age 3 or older) result from scarring during early systemic disease and include Hutchinson teeth, Mulberry molars, abnormal facies, cranial nerve VIII deafness, bony changes such as saber shins and perforations of the hard palate, [aao.org]

  Bony changes include sclerosing lesions, saber shin, frontal bossing and gummatous or destructive lesions within long bones. [hon.ch]

• Bilateral Knee Effusion

  Abstract A patient who presented with recurrent bilateral knee effusions was found to have positive serum syphilis serology. [ncbi.nlm.nih.gov]

  The common signs of late-CS include: Saber shins Swollen knees Short maxillae Hydrocephalus Flaring scapulas Hard palate defect Mental retardation Protruding mandible Bilateral knee effusions Sternoclavicular thickening Deafness from disease of the auditory [hxbenefit.com]

• Contusion

  Elsevier ‏ معاينة محدودة - 2018 عبارات ومصطلحات مألوفة abdomen abnormal Abscess abuse acquired acute ankle artery benign Bite bone brain breast cardiac cell cerebral cervical cervix chronic complication NEC condition congenital connective tissue Continued contusion [books.google.com]

• Frontal Bossing

  Common late manifestations (appear 2 yrs of age): Teeth -Hutchinson teeth (notched, pegged), mulberry molars Eye -interstitial keratitis Cranial nerves -8th nerve deafness Skeletal -frontal bossing, high arched palate, saddle nose (markedlydepressed bridge [johnsarm.net]

  Secondary Syphilis in adults Triad Hutchinson Teeth (1 st lower molors) Deafness (8 th Nerve) Interstitial Keratitis Lymphadenopahy Autoimmune Haemolytic anemia Osteochondritis and Metaphysitis Glaucoma Pseudoparalysis of parrot (Painful limbs) Saddle Nose Frontal [mediconotebook.com]

  Mulberry molars (permanent first molars with multiple poorly developed cusps). [6] frontal bossing. [en.wikipedia.org]

  These include: Fever Anemia Jaundice Deafness Irritability Petechiae Skin rashes Sabre shins Joint swelling Enlarged liver Frontal bossing Enlarged spleen Pseudoparalysis Abnormal x-rays Lymph node enlargement Poorly developed maxillae Failure to gain [hxbenefit.com]

  Bony changes include sclerosing lesions, saber shin, frontal bossing and gummatous or destructive lesions within long bones. [hon.ch]

• Polyps

  Computed tomography (CT) scan of paranasal sinus (PNS) showed perforation of palate [Figure 5] with bilateral maxillary and nasal polyps [Figure 6]. Her parents refused for biopsy of polyps. [ijstd.org]

She was asymptomatic; there was no evidence of active disease on either clinical examination or serology and no treatment was required. However, it is important to differentiate this condition from others which may require treatment. [ncbi.nlm.nih.gov]

To what extent treatment or time alone contribute to improvements cannot yet be stated. [pediatrics.aappublications.org]

King, Ambrose, “Discussion on the Treatment of Congenital Syphilis”, Brit. Journ. of Ven. Dis ., 1934, x, p. 25. [bjp.rcpsych.org]

Babies who get infected while passing through birth canal generally have a better prognosis. Congenital Syphilis Prevention Safer sexual practices can help to prevent the development of this disease. [hxbenefit.com]

Prognosis is generally good unless there are established non-reversible changes associated with tertiary syphilis 1,2. Treatment of congenital syphilis is also with bezathine penicillin G 19. [radiopaedia.org]

The prognosis is very much better in those presenting in the postneonatal period. [4] In a fetus, the neonate, and the very young infant, bone abnormalities include osteochondritis, diaphyseal osteomyelitis (osteitis), and periostitis. [2] Metaphysitis [ijri.org]

Prognosis Congenital infection can lead to spontaneous abortion or fetal demise or stillbirth. These pregnancy complications are preventable through appropriate prenatal care. [clinicaladvisor.com]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Manifestation code identifies conditions for which it is important to record both the etiology and the symptom of the disease. [books.google.com]

(Etiology) Syphilis is caused by the bacterium Treponema pallidum. Congenital transmission of syphilitic infection that takes place inside the uterus, from a mother to the infant child, causes Congenital Syphilis. [dovemed.com]

Etiology The causative organism Treponema pertenue is identical morphologically with T. palladium of syphilis. Flies of the genus Hippelates transmit infections to human beings. [drmhijazy.com]

Ongoing controversies regarding etiology, diagnosis, treatment Syphilis is uncommon among international adoptees, but congenital syphilis can go undiagnosed or may be inadequately treated in some countries. [clinicaladvisor.com]

Late congenital syphilis was diagnosed in a 22-year-old woman on the basis of clinical, serologic and epidemiologic features. [ncbi.nlm.nih.gov]

References: [7] [8] [9] [10] [11] [12] [13] Congenital and newborn listeriosis Epidemiology : Incidence in US: 3/100,000 births Pathogen : Listeria monocytogenes Transmission Clinical features Intrauterine transmission to the fetus Risk of premature birth [amboss.com]

Skin -rhagades(cracks, fissures atmucocutaneousjunctions) #1, 2, & 3 are part of Hutchinson’s triad Extended discussion Epidemiology (Treponema Pallidum): Transmitted at any time during pregnancy or at birth Transmitted at any disease stage Almost 100% [johnsarm.net]

"Syphilis: Review with Emphasis on Clinical, Epidemiologic, and Some Biologic Features". Clinical Microbiology Reviews. 12 (2): 187–209. PMC 88914. PMID 10194456. [en.wikipedia.org]

Epidemiology There are an estimated 10.6 million incident cases of syphilis worldwide each year [ 2 ]. There were 5,288 new diagnoses of syphilis in England in 2015, a 19.9% increase from 4,412 in 2014. [patient.info]

Maternal syphilis: pathophysiology and treatment. Bull World Health Organ. 2004;82:433-38. Saloojee H, Velaphi S, Goga Y, et al. The prevention and management pof congenitalsyphilis: an overview and recommendations. [rarediseases.org]

While the gestational outcomes of syphilis have been well described, the specific pathophysiologic changes occurring in utero have not been clearly elucidated. [medicalreview.columbia.edu]

Special attention is given to the prevention and treatment of these diseases found in developing countries as well as the latest findings about new antimicrobial agents, gram-negative infections and their management, and recommendations for immunization [books.google.com]

Congenital syphilis is not always preventable. In cases when congenital syphilis cannot be prevented, the impact on the health of the baby can be mitigated with proper testing, treatment, and care before and shortly after delivery. [astho.org]

We are reporting here a case of late congenital syphilis in order to emphasize that congenital syphilis still exists in 21 st century and global antenatal screening is mandatory to prevent this serious, yet largely preventable disease. [jmedicalcasereports.biomedcentral.com]

By this early diagnosis and systemic phase of treatment helped us in preventing a child from further complications, which could have been fatal. [jisppd.com]

Adequate therapy of the infected mother before the sixteenth week of gestation usually prevents infection of the fetus. [dartmouth.edu]