<prompt> A woman gave bih to a premature baby of 34 weeks. The baby showed bullous lesions all over the body and X-ray shows periosteitis. What should be the next investigation?VDRL for both mother and babyELISA for HIVPCR for TBHBsAg for mother  <response>: VDRL for both mother and baby.Its a classical clinical picture of congenital syphilis. Bullous lesions are rarely seen in adult form of syphilis but are characteristic of congenital form. VDRL is a sensitive test to diagnose congenital syphilis. Manifestations of congenital syphilis can be classified as follows: 1. Early Manifestations infectious stage: Within first years of life: Bullousmaculopapular rash, vesicles, Rhinitis and snuffles earliest sign Hepatosplenomegaly Lymphadenopathy Hematological: Coombs negative hemolytic anemia, thrombocytopenia Skeletal: OsteochondritisMetaphysitisPseudoparalysis IUGR: failure to thrive Ocular: Congenital glaucoma, chorioretinitis CNS: Leptomeningitis, hydrocephalous 2. Residual stigmata Hutchisons teeth, mulberry molars Olympian brow Saddle nose Saber shins 3. Late congenital syphilis non-infectious shows: Interstitial keratitis 8th nerve deafness Cluttons joints Asymptomatic neurosyphilis Recurrent ahropathy 