A newborn presents at 2 weeks of age with rhinitis, hepatosplenomegaly, and skin fissures at the angles of the mouth. X-ray shows periostitis of long bones. VDRL of the mother was reactive at 1:128. The pathognomonic radiological finding in congenital syphilis is:
- A Wimberger's sign — symmetrical destruction of medial tibial metaphysis ✓
- B Sabre tibia — anterior bowing of tibia
- C Clutton's joints — symmetrical knee effusions
- D Higoumenakis sign — thickening of the medial clavicle
Explanation
Wimberger's sign is the pathognomonic radiological finding of early congenital syphilis — symmetrical destruction/erosion of the medial aspects of the proximal tibial metaphysis, giving a 'rat-bitten' appearance. It results from treponema-induced osteitis and periostitis. Sabre tibia (anterior bowing due to periostitis) and Clutton's joints (interstitial keratitis + knee hydroarthrosis) are late congenital syphilis features seen after age 5. Higoumenakis sign (unilateral medial clavicular thickening) is also a late stigma. Ragades (fissures around mouth), snuffles (rhinitis), and hepatosplenomegaly are early signs appearing within 3 months of birth.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.