A Neonate With Unexplained Hair Loss

A 4-month-old girl presented with patchy hair loss, initially diagnosed as neonatal occipital alopecia, but later identified as congenital syphilis after further testing. Despite the absence of typical syphilitic facies, she exhibited hepatomegaly, splenomegaly, and skeletal abnormalities. Laboratory tests confirmed syphilis, and she was treated with intravenous penicillin G. Her parents, who had no recent sexual activity, were also diagnosed with syphilis and treated. The case highlighted that congenital syphilis, typically not associated with hair loss, can present with "moth-eaten" alopecia due to untreated maternal syphilis.