A case of early-onset congenital syphilitic osteomyelitis of the calcaneus and literature review.
Bone infection
Calcaneal osteomyelitis
Clinical features
Congenital syphilis
Treponema pallidum
Journal
BMC pediatrics
ISSN: 1471-2431
Titre abrégé: BMC Pediatr
Pays: England
ID NLM: 100967804
Informations de publication
Date de publication:
09 Oct 2024
09 Oct 2024
Historique:
received:
24
07
2024
accepted:
24
09
2024
medline:
10
10
2024
pubmed:
10
10
2024
entrez:
9
10
2024
Statut:
epublish
Résumé
Congenital syphilis (CS) is a sexually transmitted disease caused by Treponema pallidum (TP). When the skeletal system is involved, it often results in multiple, symmetrical bone destruction at the epiphyses of long tubular bones such as the humerus and radius, rarely involving the calcaneus. This article reports a case of calcaneal osteomyelitis caused by TP in a child with no other bone damage and subtle clinical manifestations, No similar cases have been reported. A 4-month-old male infant presented with right foot swelling without any obvious cause and no history of trauma. X-ray and CT scans showed bone loss in the calcaneus and surrounding soft tissue swelling. Review of past medical records revealed that the infant had been diagnosed with CS infection during a hospital stay for "pneumonia" at one month old. The parents refused surgery, opting for conservative treatment at an external hospital for three weeks, during which the symptoms of the affected foot showed no significant improvement. Subsequently, the child was treated at our hospital with surgery, including lesion removal and cast fixation, followed by oral antibiotic treatment. The last follow-up showed no swelling or tenderness in the affected foot, with good mobility, and X-rays indicated that the bone had essentially returned to normal. Early CS rarely involves the calcaneus. When diagnosing unexplained calcaneal osteomyelitis in infants, this rare cause should be considered. A thorough medical history should be taken and a careful physical examination conducted. Once diagnosed, timely surgical debridement and appropriate antibiotic therapy targeting TP infection are required. Early identification and intervention can result in a good prognosis without related complications.
Sections du résumé
BACKGROUND
BACKGROUND
Congenital syphilis (CS) is a sexually transmitted disease caused by Treponema pallidum (TP). When the skeletal system is involved, it often results in multiple, symmetrical bone destruction at the epiphyses of long tubular bones such as the humerus and radius, rarely involving the calcaneus. This article reports a case of calcaneal osteomyelitis caused by TP in a child with no other bone damage and subtle clinical manifestations, No similar cases have been reported.
CASE PRESENTATION
METHODS
A 4-month-old male infant presented with right foot swelling without any obvious cause and no history of trauma. X-ray and CT scans showed bone loss in the calcaneus and surrounding soft tissue swelling. Review of past medical records revealed that the infant had been diagnosed with CS infection during a hospital stay for "pneumonia" at one month old. The parents refused surgery, opting for conservative treatment at an external hospital for three weeks, during which the symptoms of the affected foot showed no significant improvement. Subsequently, the child was treated at our hospital with surgery, including lesion removal and cast fixation, followed by oral antibiotic treatment. The last follow-up showed no swelling or tenderness in the affected foot, with good mobility, and X-rays indicated that the bone had essentially returned to normal.
CONCLUSIONS
CONCLUSIONS
Early CS rarely involves the calcaneus. When diagnosing unexplained calcaneal osteomyelitis in infants, this rare cause should be considered. A thorough medical history should be taken and a careful physical examination conducted. Once diagnosed, timely surgical debridement and appropriate antibiotic therapy targeting TP infection are required. Early identification and intervention can result in a good prognosis without related complications.
Identifiants
pubmed: 39385133
doi: 10.1186/s12887-024-05105-2
pii: 10.1186/s12887-024-05105-2
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Case Reports
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
639Informations de copyright
© 2024. The Author(s).
Références
Peeling RW, Mabey D, Chen XS, et al. Syphilis[J]. Lancet (London England). 2023;402(10398):336–46. https://doi.org/10.1016/S0140-6736(22)02348-0 .
doi: 10.1016/S0140-6736(22)02348-0
pubmed: 37481272
Medoro AK, Sánchez PJ. Syphilis in neonates and Infants[J]. Clin Perinatol. 2021;48(2):293–309. https://doi.org/10.1016/j.clp.2021.03.005 .
doi: 10.1016/j.clp.2021.03.005
pubmed: 34030815
Hegde A, Srinivasan R, Dinakar C. Congenital syphilis: a rare presentation of a forgotten infection[J]. J Infect Dev Ctries. 2023;17(1):135–8. https://doi.org/10.3855/jidc.15498 .
doi: 10.3855/jidc.15498
pubmed: 36795921
Koliou M, Chatzicharalampous E, Charalambous M, et al. Congenital syphilis as the cause of multiple bone fractures in a young infant case report[J]. BMC Pediatr. 2022;22(1):728. https://doi.org/10.1186/s12887-022-03789-y .
doi: 10.1186/s12887-022-03789-y
pubmed: 36539748
pmcid: 9768959
Kwak J, Lamprecht C. A review of the guidelines for the evaluation and treatment of congenital syphilis[J]. Pediatr Ann. 2015;44(5):e108–14. https://doi.org/10.3928/00904481-20150512-10 .
doi: 10.3928/00904481-20150512-10
pubmed: 25996197
Patel NU, Oussedik E, Landis ET, Strowd LC. Early congenital syphilis: recognising symptoms of an increasingly prevalent Disease[J]. J Cutan Med Surg. 2018 Jan/Feb;22(1):97–9. https://doi.org/10.1177/1203475417728360 . Epub 2017 Aug 18.
Cooper JM, Sánchez PJ. Congenital syphilis[J].Semin Perinatol. 2018;42(3):176–184. https://doi.org/10.1053/j.semperi.2018.02.005 . Epub 2018 Apr 5.
Rowe CR, Newberry DM, Jnah AJ, Congenital Syphilis. A discussion of Epidemiology, diagnosis, management, and nurses’ role in early identification and Treatment[J]. Adv Neonatal Care. 2018;18(6):438–45. https://doi.org/10.1097/ANC.0000000000000534 .
doi: 10.1097/ANC.0000000000000534
pubmed: 30020089
McNeil JC. Acute Hematogenous Osteomyelitis in Children: clinical presentation and Management[J]. Infect Drug Resist. 2020;13:4459–73. https://doi.org/10.2147/IDR.S257517 .
doi: 10.2147/IDR.S257517
pubmed: 33364793
pmcid: 7751737
Kliegman RM, Stanton BF, Schor NF et al. Syphilis (Treponema pallidum). In Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Elsevier; 2012. p. 1264.
Armangil D, Canpolat FE, Yiğit S, et al. Early congenital syphilis with isolated bone involvement: a case report. Turk J Pediatr. 2009 Mar-Apr;51(2):169–71.
Scarcella A, Bortone B, Tersigni C, et al. Early limb paralysis in infants: do not forget about congenital syphilis[J]. Int J STD AIDS. 2021;32(8):768–70. https://doi.org/10.1177/0956462420987442 .
doi: 10.1177/0956462420987442
pubmed: 33533292
Dai Y, Zhai G, Zhang S, et al. The clinical characteristics and serological outcomes of infants with confirmed or suspected congenital syphilis in Shanghai, China: A Hospital-based Study[J]. Front Pediatr. 2022;10:802071. https://doi.org/10.3389/fped.2022.802071 .
doi: 10.3389/fped.2022.802071
pubmed: 35281239
pmcid: 8904424
Stephens JR, Arenth J. Wimberger sign in congenital Syphilis. J Pediatr. 2015;167(6):1451DOI. https://doi.org/10.1016/j.jpeds.2015.09 . 005.http://pubmed-ncbi-nlm-nih-gov-s.webvpn.njmu.edu.cn:8118/26427966/ .
doi: 10.1016/j.jpeds.2015.09
Rashid U, Yaqoob U, Bibi N, et al. Symptomatic early congenital syphilis: a common but Forgotten Disease. J Coll Physicians Surg Pak. 2015;25(Suppl 2):S137–9. https://doi.org/10.2015/JCPSP.S137S139 .
doi: 10.2015/JCPSP.S137S139
pubmed: 26522203
Jacobs K, Vu DM, Mony V, et al. Congenital Syphilis misdiagnosed as suspected nonaccidental trauma. Pediatrics. 2019;144(4):e20191564. https://doi.org/10.1542/peds.2019-1564 .
doi: 10.1542/peds.2019-1564
pubmed: 31537633
McCann MJ, Wells A. Calcaneal osteomyelitis: current treatment Concepts[J]. Int J Low Extrem Wounds. 2020;19(3):230–5. https://doi.org/10.1177/1534734619895187 .
doi: 10.1177/1534734619895187
pubmed: 31852303
Rac MWF, Stafford IA, Eppes CS. Congenital syphilis: a contemporary update on an ancient disease[J]. Prenat Diagn. 2020;40(13):1703–14. https://doi.org/10.1002/pd.5728 .
doi: 10.1002/pd.5728
pubmed: 32362058
Mooney ML, Haidet K, Liu J, et al. Hematogenous Calcaneal Osteomyelitis in Children. Foot Ankle Spec. 2017;10(1):63–8. https://doi.org/10.1177/1938640016679704 .
doi: 10.1177/1938640016679704
pubmed: 27881832