An Infant with Seizures, Rash, and Hepatosplenomegaly (See pages 451–2 for the Photo Quiz)

Figure 2. Scalp of the infant, showing crusted erythematous erosion following a ruptured bullae. Figure 1. Scaly, erythematous erosions with collaretes of crust and numerous bullae covering the entire lower limbs of the neonate. Diagnosis: congenital syphilis. The infant’s rapid plasma reagin test was reactive at a titer of 1:256 dilutions; a Treponema pallidum particle agglutination assay and fluorescent treponemal antibody absorption test were also reactive. A CSF sample that was obtained after the patient had received 4 days of antibiotics revealed a WBC count of 6 cells/mm3 (7 % polymorphonuclear cells, 70 % lymphocytes, and 23 % monocytes and macrophages), an RBC count of 32 cells/ mm3, a protein level of 0.43 g/L, and a glucose level of 2.2 mmol/L; a Venereal Disease Research Laboratory test was non-reactive. Long-bone radiographs and MRIs of the brain ha