Necrotizing Enterocolitis Secondary to Congenital Syphilis in an 18-Day-Old Neonate: Successful Treatment With Intravenous Penicillin.

Congenital syphilis remains a preventable yet persistent global health challenge, particularly in resource-limited countries. Gastrointestinal involvement is uncommon, and necrotizing enterocolitis (NEC) has rarely been reported as a manifestation of early congenital syphilis. We present the case of an 18-day-old neonate who was initially admitted with a diagnosis of NEC, with abdominal distension, feeding intolerance, and characteristic radiologic signs, corresponding to Grade IIb NEC according to the Modified Bell criteria. However, the presence of desquamation on the soles, along with a markedly enlarged liver, warranted a test for congenital syphilis, which was subsequently confirmed. The infant was successfully treated with intravenous penicillin alongside standard medical therapy for NEC, resulting in clinical recovery without surgical intervention. This case underscores the role of Treponema pallidum as a potential, yet often unrecognized, causative agent of NEC in neonates. Early recognition and timely, targeted antibiotic therapy are critical to preventing severe complications.