A Solitary Skull Lesion of Syphilitic Osteomyelitis

Abstract

We experienced a rare case of solitary syphilitic osteomyelitis of the skull without any other clinical signs or symptoms of syphilis. A 20-year-old man was referred due to intermittent headache and mild tenderness at the right parietal area of the skull with a palpable coin-sized lesion of softened cortical bone. On radiological studies, the lesion was a radiolucent well enhanced mass (17 mm in diameter). The erythrocyte sedimentation rate (52 mm/h) and C-reactive protein (2.24 mg/dL) were elevated on admission. Serum venereal disease research laboratory (VDRL) and Treponema pallidum haemagglutination assay (TPHA) tests were positive. There were no clinical signs or symptoms of syphilis. After treatment with benzathine penicillin, we removed the lesion and performed cranioplasty. The pathologic finding of the skull lesion was fibrous proliferation with lymphoplasmocytic infiltration forming an osteolytic lesion. In addition, a spirochete was identified using the Warthin-starry stain. The polymerase chain reaction study showed a positive band for Treponema pallidum. Solitary osteomyelitis of the skull can be the initial presenting pathological lesion of syphilis.

Treponemal disease in the Old World? Integrated palaeopathological assessment of a 9th–11th century skeleton from north-central Spain

“…While full certainty can hardly be achieved even combining all these methods, a detailed analysis of skull and bone lesions is still considered the most reliable method for identification of acquired syphilis in past populations (Ortner, 2009). In this case, the CT appearance of our specimen (Figure 6) is very similar to images which have been reported by Gurland et al (2001) and Huang et al (2007) in HIV-infected patients with acquired syphilis; and also by Kang et al (2010) in a patient with confirmed T. pallidum infection. This morphological appearance has been previously reported as characteristic of acquired treponemal infection on radiographic and palaeopathological assessments (Thompson and Preston, 1952;Ortner, 2003;Shang and Trinkaus, 2008;Boone et al, 2009;Reinus, 2010).…”

An Isolated Skull Lesion in Syphilis

“…Syphilitic osteomyelitis usually occurs as multiple lesions, and solitary lesion was rarely reported . Our patient did not have tenderness and swelling unlike earlier published cases .…”

Rare Types of Trephination from Hungary Shed New Light on Possible Cross-cultural Connections in the Carpathian Basin

“…Infectious conditions like syphilis (Kang et al , ) or tuberculosis (Raut et al , ; Dawson and Robson Brown, ) can affect the skull causing solitary round lytic lesions, although not ectocranially.…”

“…Infectious conditions like syphilis (Kang et al, 2010) or tuberculosis (Raut et al, 2004;Dawson and Robson…”