Intracardiac mass in a 3-month-old boy revealing a congenital syphilis

The rate of congenital syphilis remains low in developed countries, as most women with syphilis are routinely screened and treated during pregnancy. We report here the case of a 3-month-old boy, with fever that lasted 15-days referred to the emergency department of tertiary care paediatric center. He had no history and had never travelled. Examination showed severe pallor, slight forehead bulging and large isolated hepatomegaly. Blood tests found: anaemia, elevated C-reactive protein and hyperlymphocytosis. Echocardiography found an intracardiac mass on the posterior wall of the right atrium extending to the origin of the superior vena cava. Cardiac MRI confirmed that mass. The Treponemal Hemagglutination Assay (TPHA) and non-treponemal test (Venereal Disease Research Laboratory, VDRL) were highly positive. Prolonged antibiotic therapy with penicillin G resulted in good clinical evolution, disappearance of lymphocytosis and total disappearance of the mass at 20-months' follow-up.