Congenital syphilis in a preterm neonate with arthrogryposis‑like phenotype and neurosyphilis: A report of a rare case 

Congenital syphilis remains a critical public health concern, particularly in regions with limited prenatal screening. The present case report describes the case of a preterm male neonate with congenital syphilis presenting with a rare arthrogryposis‑like phenotype characterized by multiple joint contractures, limb deformities and fixed hyperextended postures, together with neurosyphilis. The neonate presented with prematurity, low birth weight, maculopapular rash, hepatosplenomegaly, snuffles, jaundice, micropenis, lethargy and poor feeding. Investigations revealed a rapid plasma reagin (RPR) titre of 1:128, cerebrospinal fluid lymphocytosis, elevated protein levels, low glucose levels and a positive cerebrospinal fluid VDRL, confirming neurosyphilis. The infant was treated with aqueous crystalline penicillin G for 10 days, with supportive neonatal care, including oxygen and phototherapy. The clinical course was favorable, with an improvement in feeding, activity, jaundice and skin manifestations prior to discharge. In this illustrative follow‑up scenario, the RPR titre declined 4‑fold by 3 months and continued to decline on subsequent testing; neurological findings improved, while the arthrogryposis‑like contractures exhibited a partial improvement with physiotherapy. Continued serological, neurological, developmental and orthopedic follow‑up was planned. The present case report emphasizes that an arthrogryposis‑­like phenotype may be an unusual presentation of congenital syphilis and highlights the importance of early recognition, treatment and structured follow‑up.