The Roentgenographic and Pathologic Aspects of Congenital Osseous Syphilis

Abstract

The skeletal lesions of congenital syphilis have been exhaustively studied by European roentgenologists and pathologists, particularly in Germany and France, but in this country and Great Britain limited attention has been paid to this aspect of the disease. One seems justified, therefore, in attempting an exposition of this subject in English based on the study of roentgenograms of the bones of 102 patients with congenital syphilis, in 24 of whom gross and microscopic examination of pathologic material was made.The histopathology of congenital syphilis of the bone is still obscured by many unsolved problems. Both pathologists and roentgenologists have entered into the controversy regarding many debatable points. In the following study, undertaken with the cooperation of certain members of the intern, pathologic and x-ray staff of the Babies' Hospital, which aims to be essentially practical, the controversial points will be touched on only lightly, since the object is to limit the scope to the fundamental features as correlated by roentgenologic and histopathologic examinations.HISTORICAL DATA A presentation of this subject would be incomplete without a chron¬ ologic list of those who have made important investigations in the same field, thus demonstrating the increasing length of the base line of endeavor that has lightened the task of successive workers. Nils Rosen, of Uppsala,1 in 1778, was the first to emphasize the value of skeletal examination in every case of congenital syphilis.

Congenital syphilis as the cause of multiple bone fractures in a young infant case report

“…In 1931 McLean published a series of 102 patients where he described three main types of skeletal anomalies ie osteochondritis, periostitis, osteomyelitis and more rarely osteitis [18]. In 1953 Engeset, Eek and Gilje in their study of 59 cases, suggested that skeletal changes were the result of disturbance in bone growth instead of inflammation [19].…”

Persistent bony lesions in congenital syphilis

“…Diaphysitis or osteitis produces a moth-eaten appearance as a consequence of focal cortical destruction. In infants, periostitis is associated with periosteal elevation and a lucent space between periosteum and bone [8,9,10,14,15,16,17,18,21,24,26,28].…”

“…The long bone involvement is reported to be bilateral and symmetrical in almost 100% of cases, although unilateral cases have been described [2,4,5,7,11,12,14,15,19,21,24,25,27]. The bony lesions heal completely after treatment, with normal growth during the first two years of life, and without residual deformity [1,2,4,6,7,9].…”