Parrot’s pseudoparalysis in congenital syphilis

Introduction: Congenital syphilis is an intrauterine infection transmitted by the spirochete Treponema pallidum, and it is the most common congenital infection in the world. Cases of congenital syphilis continue to rise in the United States, and prompt clinical diagnosis of those cases that escape prenatal screening is critical given the wide availability of treatment and prevention of long-term sequela when treatment is provided.
 
Case Presentation: Here we report an infant who presented with irritability and apparent paralysis of the right upper extremity, consistent with Parrot’s pseudoparalysis, a classic physical exam finding in congenital syphilis. The infant was treated with intravenous penicillin G for 10 days. In the following months, the infant’s symptoms improved – she was able to move all limbs comfortably and the pseudoparalysis completely subsided. Cranial and eye exams were normal. Her liver function tests normalized, and repeat non-treponemal antibodies fell at a slow rate over several months. Her growth and development were appropriate for age.
 
Conclusions: This case illustrates the importance of recognizing pseudoparalysis of Parrot and of considering congenital syphilis in an infant with bone pain or apparent paresis. Prior reports of pseudoparalysis of Parrot are reviewed.