The patient's erythrocyte sedimentation rate was 130 mm/h (Westergren method), and the Mantoux tuberculin skin test was positive with an induration of 30 mm. Results from complete blood cell count confirmed a severe hypochromic, microcytic anemia (hemoglobin, 70 g/L). The child's rapid plasma reagin titer for syphilis was 1:512; the mother's, 1:64. Findings from human immunodeficiency virus serology were negative. A chest radiograph was unremarkable, and a single orbital lytic lesion was noticed on a lateral radiograph of the skull. Surgical drainage of the soft tissues of the right hand yielded thick pus and granulomatous tissue. Mycobacterium tuberculosis (TB) susceptible to isoniazid and rifampin was obtained from tissue culture. The child was treated for congenital syphilis with penicillin G procaine intramuscularly daily for 10 days and for TB with isoniazid, rifampin, and pyrazinamide for 12 months. Clinical and radiological responses after 5 months were remarkable.