Congenital bilateral periostitis: Differential diagnosis and a case report

Introduction: Periostitis, characterized by radiological findings of periosteal new bone formation, can result from various factors including trauma, drugs, infection, and tumors. Among infants up to six months of age, common causes of periostitis include physiologic periostitis of the newborn, Caffey disease, periostitis related to prostaglandin use, and congenital syphilis. The differential diagnosis of bilateral symmetrical periostitis in newborns and infants within this age range is important as it contributes to the possibility for early treatment. Case Report: A 3-month-old girl, born at 38 weeks by natural birth and with unremarkable prenatal history, presented with multiple episodes of vomiting, loss of appetite, fever, saddle nose, prominent forehead, maculopapular rash with vesicles in both palms, and a palpable liver. Her weight was below the 3rd percentile on growth charts. The infant’s syphilis serum screening test was reactive, leading to further testing. Treatment with crystalline penicillin G was administered, and diagnostic investigations revealed symmetrical periostitis affecting the diaphysis of bilateral femorae and tibiae. Conclusion: This case report highlights the importance of considering congenital syphilis in the differential diagnosis of bilateral symmetrical periostitis in newborns and infants up to six months of age. Early diagnosis and appropriate treatment are crucial. This case report adds to the orthopedic literature by presenting a unique case of congenital syphilis-associated periostitis, emphasizing the significance of considering this etiology in similar clinical scenarios. Increasing awareness of such cases can lead to prompt diagnosis and intervention, ultimately contributing to better clinical outcomes in affected infants.