= CONGENITAL RUBELLA = GERMAN MEASLES

Prevalence: endemic rate of 0.1%

Age: infants (in utero transmission)

• neonatal dwarfism ← intrauterine growth retardation
• retinopathy, cataracts, glaucoma, microphthalmia
• deafness; mental deficiency with encephalitis + microcephaly
• thrombocytopenic purpura, petechiae, anemia; failure to thrive
• “celery-stalk” sign (50%) = irregular metaphyseal margins + coarsened trabeculae extending longitudinally from epiphysis; distal end of femur >proximal end of tibia, humerus
• no periosteal reaction
• hepatosplenomegaly + adenopathy
• pneumonitis
• Cardiovascular:
  • congenital heart disease (PDA, VSD)
  • peripheral pulmonary artery stenosis
  • necrosis of myocardium
• CNS
  • punctate / nodular calcifications
  • porencephalic cysts
  • occasionally microcephaly

Prognosis: osseous manifestations disappear in 1–3 months; severe congenital defects from infection during first trimester

DDx:

1. CMV
2. Congenital syphilis (diaphysitis + epiphysitis)
3. Toxoplasmosis