Acute periostitis in early acquired syphilis.

Roy, Reena; Laird, S. M.

doi:10.1136/sti.49.6.555

Cited by 13 publications

(7 citation statements)

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“…Only minimal radiological changes were seen in Case 1 and none in Case 2, in contrast to the fairly florid changes found in congenital or late syphilis (King et al 1980b). Periostitis is a well known feature of secondary syphilis (Reynolds & Wasserman 1942, Roy & Laird 1973, King et al 1980a). There are several reasons why the diagnosis of periostitis may be missed in secondary syphilis: (1) the bony lesions may remain asymptomatic; (2) early syphilitic periostitis and osteomyelitis seldom produce radiological changes (Roy & Laird 1973); (3) headache due to skeletal lesions may be attributed to meningeal involvement.…”

Section: Discussionmentioning

confidence: 99%

“…Periostitis is a well known feature of secondary syphilis (Reynolds & Wasserman 1942, Roy & Laird 1973, King et al 1980a). There are several reasons why the diagnosis of periostitis may be missed in secondary syphilis: (1) the bony lesions may remain asymptomatic; (2) early syphilitic periostitis and osteomyelitis seldom produce radiological changes (Roy & Laird 1973); (3) headache due to skeletal lesions may be attributed to meningeal involvement. In the two patients reported, the diagnosis of periostitis would have been missed if bone scintigraphy had not been carried out.…”

Section: Discussionmentioning

confidence: 99%

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Periostitis in Secondary Syphilis: A Place for Bone Scintigraphy

et al. 1985

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A Saeed MRCOG Department ofGenito-Urinary Medicine, Royal Lancaster Infirmary, Lancaster Summary: Two cases of secondary syphilis are reported with periostitis as the main presenting feature. Technetium-99m bone scintigraphy was found to be superior to radiography in both defining the extent of involvement and in picking up early lesions. Case reportsCase 1: A 35-year-old unmarried Irish woman working as an office secretary was referred to the Rheumatology Clinic at St George's Hospital on 28 September 1983 with a history of pain and tenderness in the neck following a fall from a bicycle at the end of July that year. Three weeks previously she had developed pain, tenderness and swelling over both shins. For one week she had noticed spontaneous bruising over the right shin, right buttock and left thigh, and had felt unwell. On direct questioning she reported that a papular non-pruritic rash had appeared on her trunk two weeks before. This had coincided with taking ibuprofen, started by her general practitioner, and the rash was attributed toz an idiosyncratic reaction to the drug. The rash disappeared three days after stopping the drug. It had lasted for about a week. There was no history of orogenital ulceration. She had been sexually active and her partner travelled abroad frequently.On examination, she was found to be a fit-looking woman, with bruises over the right buttock and anterior part of the right leg. No rash was evident, and no orogenital lesions or lymphadenopathy could be seen. Both tibiae were tender, but there was no pre-tibial oedema. An area of tenderness was found over the lower cervical spine, with limitation of lateral flexion and rotation. The skull and the other long bones were not tender. Neurological and remaining systematic examination were normal.Routine investigations were normal apart from an erythrocyte sedimentation rate (ESR) of 54mm in the first hour, and a leukocytosis of 10.2 x 109/1. Coagulation profile and bone marrow examination were normal. Autoantibody screen was negative. Radiological skeletal survey did not reveal any abnormalities. However, a technetium-99m (99mTc) bone scan showed multiple areas of increased uptake mainly over the skull and long bones, where it was in the form of a streaky linear pattern (Figures 1 & 2). Soon after admission she began to lose the lateral parts of her eyebrows, as well as her eyelashes. A maculopapular, non-pruritic rash appeared on her trunk but faded without treatment over three days.Serology for syphilis was then assessed: rapid plasma reagin (RPR) card test positive 1:128, treponemal haemagglutination (TPHA) positive, fluorescent treponemal antibody (FTA) test positive. Skin biopsy of the rash showed areas of perivascular infiltration with plasma cells, consistent with lesions of secondary syphilis. Treatment with procaine penicillin was instituted (1.2 megaunits intramuscularly for ten days).IPaper arising from presentation ofCase I

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Periostitis in Secondary Syphilis: A Place for Bone Scintigraphy

et al. 1985

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“…It can present as periostitis, arthritis, osteitis or osteomyelitis. Syphilitic periostitis was originally described in 1887 by J Hutchinson as quoted by Roy et al 1. Periostitis in particular is rarely reported.…”

Section: Discussionmentioning

confidence: 97%

“…Clinically, there is tenderness over the involved bones, which is sharply localised and may be accompanied by local pitting oedema 1. Pain is aggravated during the night6 and on exposure to heat 1…”

Section: Discussionmentioning

confidence: 99%

Syphilitic periostitis of the skull and ribs in a HIV positive patient

Samarkos

Giannopoulou

Karantoni

et al. 2010

Sexually Transmitted Infections

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“…Wile and Senear reported bone and joint invasion in 36% of their 165 patients with early acquired syphilis.2 Reynolds and Wasserman, however, reported an incidence of only 0-15% of destructive bone disease in early acquired syphilis.3 There is also some evidence that bone involvement is not uncommon, but perhaps only rarely appreciated because radiological findings may be normal at this stage. 5 The bony involvement may be in the form of proliferative periostitis or osteolytic lesion or both, former being the commoner. The bones most often affected are the skull and the long bones of the limbs, the legs more frequently than the arms, followed by sternum and ribs.…”

Section: Discussionmentioning

confidence: 99%