Figure 2.70. Marked hepatosplenomegaly in an infant with congenital syphilis. Hepatomegaly occurs in 50 to 60% of affected infants. It is frequently associated with jaundice, anemia, splenomegaly and ascites. In the spectrum of congenital syphilis there may be no clinical signs of disease at birth or there may be many clinical manifestations which include intrauterine growth retardation, skin manifestations, hepa-tosplenomegaly, jaundice, anemia, thrombocytopenia, and osseous changes.
Figure 2.71. This infant with massive ascites secondary to congenital syphilis associated with respiratory distress, improved dramatically after abdominal paracentesis. This degree of ascites caused dystocia, necessitating a cesarean delivery.
Figure 2.72. In an infant aged 6 weeks widi die typical findings of congenital syphilis, note die circiiiate lesions over the forehead, die excoriation at the nose due to rhinitis, and the cheilitis at die corners of the mouth. Rhinitis ("snuffles") usually appears between the 2nd to 6th week of life and is the result of ulceration of the nasal mucosa. When the ulceration is deep enough to involve the cartilage of the nasal bone, die architecture is destroyed, thus giving rise to the classic saddle nose deformity. Mucous membrane patches are seen in approximately one-third of infants with congenital syphilis. At the mucocutaneous junctions these lesions tend to weep and may cause fissures (cheilitis) which often extend from the lips in a radiating fashion over the surrounding skin. When deep, these lesions may leave residual scars (rhagades).
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