Congenital syphilis: Osteitis

Note the extensive destruction, with metaphyseal (arrows) and diaphyseal radiolucencies throughout the humerus, radius, and ulna. Observe the exuberant periosteal overgrowth, with expansile deformity of the bones of the upper extremity. Syphilitic granulation tissue may extend from the metaphysis to the diaphysis, creating an extension of the infectious focus. Reactive sclerosis often surrounds the osteolytic lesions, with associated periostitis of the long tubular bones.