From the Department of Paediatrics and Child Health, University of Stellenbosch, Tygerberg, South Africa.
A 13-MONTH-OLD girl fell and had painful swelling of the right ankle on which she did not want to bear weight. Delivery was at term after an uncomplicated pregnancy. The mother's venereal disease research laboratory serology test for syphilis was negative early in pregnancy, and it was not repeated. Immunizations, including BCG vaccine, were up to date. Two adults in the house hold had pulmonary tuberculosis. The child was notevaluated and received no tuberculosis chemoprophylaxis. The child weighed 10.2 kg (50th percentile) and was 80 cm long (75th-90th percentile). Her temperature was normal, she was anemic, had submandibular and inguinal lymphadenopathy, swelling and tenderness of the right ankle and lower leg, and to a lesser degree, of the left ankle and lower leg. The ulnar aspect of the right hand was swollen, and cardiovascular, respiratory, and abdominal examination findings were normal. Symmetrical, flat, dark perianal lesions were observed, suggesting condylomata lata. Radiographs of both lower extremities (Figure 1) and hands (Figure 2) were obtained.
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The Rational Clinical Examination
Make the Diagnosis: Early Pregnancy
The Rational Clinical Examination
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