Case of the Week: May 6-May 13, 2005

Newborn, infant with hepatomegaly.

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Case Details

Answer

Diagnosis: Congenital Syphilis with Wimberger’s sign

Congenital syphilis is one of the congenital intrauterine (“TORCH”) infections. Clinical manifestations may include hepatosplenomegaly, skin rash, lymphadenopathy and anemia. Bony changes of congenital syphilis predominately involve the bone metaphyses. Radiographic findings of bony involvement include metaphyseal lucent bands, which may be a nonspecific response to systemic illness or may be due to syphilitic granulation tissue in the metaphyses. A more specific finding is localized bony destruction of the medial portion of the proximal tibial metaphysis (Wimberger’s sign). Other findings include metaphyseal serration (“sawtooth metaphyses”), and diaphyseal involvement with periosteal reaction.

Other entities that can mimic Wimberger’s sign include neonatal hyperparathyroidism and osteomyelitis. Bony destruction in congenital syphilis may lead to pathologic fractures, and may mimic battered child syndrome.  

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VCU Department of Pediatric Radiology Virginia Commonwealth University VCU Medical Center