Background Although congenital syphilis and congenital CMV infections are preventable they are still the major causes of perinatal mortality and morbidity. Expectant mothers from lower socioeconomical status and intravenous drug users belong to the highest risk groups for vertical transmission of infections. Here we present a coexistence of congenital syphilis and CMV infection complicated with multiplex jejunal atresia.

Methods Clinical analysis, laboratory, serological and PCR examinations.

Case presentation 990 grams, 38 cm height (pc.75–91) girl was born to an intravenous drug user mother on the 26th gestational week. The expectant mother did not participated in the prenatal care and early latent syphilis (RPR 1:128 positive, TPPA and TpELISA positive), genital Streptococcus agalactiae and fungal infectionwere detected shortly before delivery.

The preterm and immature girl had jaundice, oedema, gluteal haematome and petechiae. Extremely enlarged liver and spleen (reaching the hip bone) and increased muscle tone with rigid joints were found. Multiple jejunal atresia was detected by bedside X-ray examination.

Anisocytosis, thrombocytopenia, elevated liver enzymes (ASAT: 3850, ALAT: 558, GGT: 292, ALP: 436) and elevated LDH (38180) and CK (7.1) with direct hyperbilirubinaemia were found.

During microbiological examinations high copy of CMV virus number was detected by quantitative real-time PCR and syphilis serology was positive (RPR: 1:16 positive, TPPA, Tp ELISA, T. pallidum IgM immunoblot positive).

Intravenous penicilline-G (100.000 IU/kg/dose for 10 days) and intravenous ganciclovir was administered. Gancyilovir was stopped after 4 weeks because of progressing thrombocytopenia. The multiplex jejunal atresia was fixed by operation resulting in satisfactory intestinal passage.

Conclusions Although syphilis screening test within the prenatal care is mandatory in Hungary, congenital syphilis cases do occur. Immature immune system is predisposing factor for coinfections of a newborn. The symptoms of T. pallidum and CMV infection is very similar, presenting a diagnostic challenge.