Korean J Pediatr 2011;54(12):512-514 • http://dx.doi.org/10.3345/kjp.2011.54.12.512 513 spontaneous vaginal delivery and the birth weight was 3,270 g. Upon physical examination, his height was 61.5 cm (25 to 50th percentile), weight was 6.5 kg (25 to 50th percentile), and head cir- cumference was 39.5 cm (10 to 25th percentile). He ate only a small amount of milk and his activity was decreased. His abdomen was soft and liver and spleen were not palpable. He had generalized erythe- matous, targetoid, scaly macules, papules, pustules (Fig. 1A) and desquamation at the hand and foot (Fig. 1B). Complete blood cell counts demonstrated normocytic normochromic anemia (hemoglobin 8.3 g/dL and hematocrit 27.8%) with leukocytosis (white blood cell [WBC] 20,000/mm3 with neutrophils 43%, lymphocytes 52%, monocytes 4%, eosinophils 1%) and throm- bocytopenia (86,000/Lµ). His serum total protein was 4.9 g/dL with an albumin level of 2.7 g/dL. Result of liver function tests were normal with aspartate aminotransferase activity 47 IU/L, alanine aminotransferase activity 18 IU/L, and total bilirubin 0.4 mg/dL, with a direct bilirubin of 0.2 mg/dL. Serum iron levels were normal and the results of a Coombs' test were negative. Serologic tests for cytomegalovirus, Rubella, Herpes simplex virus and Toxoplasmosis were all negative. His blood venereal disease research laboratory (VDRL) test was positive in was positive in 1:32 dilutions and cerebrospinal fluid (CSF) VDRL analysis positive with 1:1 dilution. Laboratory studies of the CSF showed the following values: WBCs, 5/mm3; red blood cells, 40/mm3; protein, 26.3 mg/dL; glucose, 68 mg/dL, with a plasma glucose level of 156 mg/dL. As his non-treponemal test for syphilis was positive, treponemal test was done. His syphilis serology test showed a positive fluorescent-treponemal antibody-absorbed test immunoglobulin M as well asT. pallidum hemagglutination assay test. No organism was identified in any culture specimen, such as blood, urine or CSF. Although radiographic examination of the infant’s long bones showed diaphyseal periostitis (Fig. 2), no abnormality was detected on brain magnetic resonance imaging. And hearing test was normal. After we diagnosed his illness as congenital syphilis, his parents were tested for syphilis and the mother’s VDRL was found to be reactive with 1:4 dilutions and the father's VDRL was found to be reactive with a 1:1 dilution. Nevertheless this result, his mother had no specific symptoms. Based on these findings, the mother’s VDRL results during prenatal care were erroneous. We treated the patient with procaine penicillin G for 14 days. His skin eruption was resolved within several days. After 4 days of penicillin, results of serology test returned to normal with platelet count of 235,000/µ L, WBC count of 13,670/mm3. During two weeks of hospitalization, the anemia slowly improved. Hemoglobin was increased to 10.0 g/dL with hematocrit 31.4%. Also, total protein was Fig. 1. Generalized erythematous, targetoid, scaly macules, papules, and pustules (A), and desquamation of the patient’s hand (B). Fig. 2. Radiographic examination of the long bones demonstrated dia­ physeal periostitis, indicating syphilitic changes.