A case of tertiary neurosyphilis presenting with moth-eaten bone lesions

Abstract

Syphilis, the "great imitator," with regard to skin diseases, is a chronic systemic infectious disease with a clinical course that waxes and wanes. The incidence of tertiary syphilis had decreased drastically these decades. We report a case of tertiary neurosyphilis presenting with moth-eaten bone lesions of the lower extremities. To the best of our knowledge, we have not seen such reports.

Challenges in the Diagnosis of Tertiary Syphilis: Case Report with Literature Review

“…Late symptomatic syphilis is a rare systemic disease that can affect the skin, the mucous membranes, the circulatory system, the nervous system and the skeletal system. The incidence of tertiary syphilis decreases significantly with the introduction of penicillin in its early stage, but new cases of this disease are still being reported [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ,…”

“…Bone lesions in tertiary syphilis are currently rarely described [ 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. A group of researchers led by Wang presented a case of a 47-year-old woman with a gumma in the vertebral body of the thoracic spine and positive serum reactions, primarily suspected of a proliferative process.…”

“…In order to illustrate this issue, the PubMed database was searched for cases of tertiary syphilis in the last 10 years. 22 cases of late skin syphilis (including one in Poland) [ 14 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 47 ], 21 cases of cardiovascular system syphilis [ 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 ], five cases of systemic syphilis (the liver, the pancreas, the adrenal glands) [ 73 , 74 , 75 , 76 , 77 ], 11 cases of syphilis affecting bones [ 41 , 42 , 43 , 44 , 45 , 46 ,…”

“…Syphilis can be divided into primary and secondary stage early syphilis (within one year of infection), and late latent and symptomatic syphilis [ 10 ]. The number of cases of late symptomatic syphilis have dropped significantly since the implementation of penicillin to treat early syphilis [ 11 ], but occasional cases of tertiary syphilis are still noted [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ,…”

Moth eaten: Infiltrative destruction of bone

“…Moth eaten is also described in tertiary syphilis in the bone . Interestingly, secondary syphilis is also a recognised cause of hair loss described as moth eaten alopecia.…”