A 3-week-old infant born to a mother with untreated syphilis presents with persistent purulent nasal discharge ('snuffles'), a desquamating maculopapular eruption involving the palms and soles, and hepatosplenomegaly. Which additional finding would place the child in the late congenital syphilis category rather than early disease?

• A Osteochondritis of the long bones on radiographs
• B Notched, peg-shaped permanent central incisors ✓
• C Generalised lymphadenopathy
• D Hydrops fetalis detected before delivery

Explanation

Early congenital syphilis manifests within the first two years with snuffles, palmoplantar rash, hepatosplenomegaly, lymphadenopathy, haemolytic anaemia and osteochondritis. Late manifestations appear after age two and include Hutchinson's notched incisors, mulberry molars, interstitial keratitis, eighth nerve deafness and saddle nose. Options A, C and D are all features of early congenital syphilis, while the dental deformity reflects defective enamel formation of developing permanent teeth, a classic late sign.

Reference: Nelson Textbook of Pediatrics, 22nd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.