Figure 2.85. Radiograph of the lower extremities of the same infant as in Figure 2.84 at age 6 months. Note the marked alterations of the contour and thickness of the femora. The cortex is thin and the medullary cavity is expanded. The proximal end of the left femur is severely damaged due to syphilitic osteomyelitis. This may present as a syphilitic arthritis of the hip. In spite of these extensive changes, infantile luetic osteitis usually improves remarkably.

Figure 2.86. Radiograph of the left humerus in an infant with congenital syphilis showing periostitis which was present at birth. The lesions of periostitis are usually diffuse and frequently extend over the entire length of the involved bone. It is first seen as a thin even line of calcification outside the cortex of the involved bone; the lesions progress and eventually produce calcification and thickening of the cortex. When severe, this leads to a permanent deformity such as anterior bowing of the tibia (saber shins). Periostitis of the frontal bones of the skull, when severe, is responsible for the flat overhanging forehead that may persist as a stigma of congenital syphilis in infancy.

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