A case of syphilitic osteitis in a patient with HIV infection

Abstract

Summary Osteitis is an under-recognized clinical manifestation of early syphilis, especially in patients with HIV. We report here a case of syphilitic osteitis of the skull and review its clinical presentation, diagnosis, and management.

Calvarial lytic lesions in neurosyphilis with ocular involvement

“…Various degrees of osseous involvement in syphilis have been documented in the literature [3] , [4] , [5] , [6] , [7] , [8] , with one of the earliest studies suggesting bone involvement as an uncommon sequela of infection [9] . Calvarial lytic lesions in secondary and tertiary syphilis have been identified in a minority of cases [3] , [4] , [5] , [6] , [7] with diverse clinical presentations ranging from asymptomatic infection to a skull mass with chronic headaches [5] , [7] , [8] . Given the rarity of cases, no large scale studies have been performed to generate guidelines for management of syphilitic osteomyelitis.…”

“…Given the rarity of cases, no large scale studies have been performed to generate guidelines for management of syphilitic osteomyelitis. Treatment with parenteral Penicillin has resulted in clinical improvement in several cases of syphilitic osteomyelitis [3] , [4] , [5] , [6] , [7] , [8] , however, there is no consensus in favor of a particular route of administration or duration of treatment.…”

“…Additionally there is conflicting evidence regarding the utility of post-treatment imaging in determining therapeutic impact as certain studies have demonstrated improvement of bone lesions after antibiotic therapy [4] , [5] , [7] , [8] , while others witnessed delayed to no significant changes in lesions [3] , [9] , [14] . Determination of the most efficacious imaging modality for evaluating syphilitic lesions post-treatment requires further investigation, as CT and PET imaging both appear to be reasonable choices for evaluating therapeutic impact [15] .…”

“…Rates of syphilitic infections in the United States have increased annually since 2000, with 129,813 cases reported in 2019 [2] . Notably, cases of osseous involvement in syphilis have been documented in the literature [3] , [4] , [5] , [6] , [7] , however, there exist no guidelines for management or therapeutic endpoints in the treatment of syphilitic osteomyelitis. We present a unique case of calvarial lytic lesions in neurosyphilis with ocular involvement with the goal of inviting further investigations into the management of syphilitic osteomyelitis.…”

Lesión osteolítica de calota por sífilis secundaria

“…El compromiso óseo en la sífilis secundaria es un hallazgo infrecuente, existiendo sólo series y comunicaciones de casos 8,10,11 . Sin embargo, en los últimos años, éstos han ido aumentando debido a la co-infección con VIH 12,13 . A pesar de su infrecuencia, su diagnóstico es importante ya que puede ocasionar la destrucción y deformidad del hueso, provocando desde trastornos funcionales hasta la muerte secundario a la sepsis 14 .…”