Bone pain as the presenting manifestation of secondary syphilis.

Abstract

A 31 year old fireman presented with acute pain and tenderness in both shins and forearms. Radiographs were normal but bone scintigraphy showed widespread increased isotope uptake. Serology was consistent with a diagnosis of secondary syphilis, and the patient's symptoms resolved completely six weeks after a course of penicillin.Periostitis is a recognised but rare manifestation of secondary syphilis' and usually occurs in conjunction with other cutaneous and mucosal lesions. We describe a case in which bone pain was the only presenting feature and confirm recent reports of the value of bone scintigraphy in detecting early periostitic lesions.2Case report A 31 year old fireman presented with a two week history of pain in both shins and along the ulnar borders of both forearms. His pain was worse at night, keeping him awake, and his limbs felt tender to touch. He was a sexually active homosexual and had noticed mild anal discomfort for the previous 10 days. He was otherwise well and when directly questioned reported no rashes, eye symptoms, arthralgia, or other orogenital symptoms.On examination he was a fit young man with no rash, mucocutaneous lesions, or lymphadenopathy. He was acutely tender along the anterior borders of both tibiae, and there were 41;# localised areas of tenderness along both ulnae. Rectal examination showed mild proctitis. There was no arthritis and neurological and remaining systemic examination was normal.Routine investigations were normal apart from an erythrocyte sedimentation rate (ESR) of 88 mm in the first hour and an alkaline phosphatase of 1193 IU/l (normal <280

Is Unresolved Inflammatory Angiogenesis a Mechanism for the Delayed Development of Skeletal Lesions in Syphilis?

“…During the secondary phase, evidence of angiogenesis has been reported in cutaneous lesions (Macaron et al ., ), and the presence of inflammatory infiltrates of lymphocytes and plasma cells has been noted (Huang et al ., ). Solitary bone lesions have also been observed (Kang et al ., ) along with cases of bone pain (Middleton et al ., ). An improperly ordered healing process can result in persistent inflammation (Costa et al ., ).…”

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

“…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…”

Unusual Presentation of Secondary Syphilis in Korea: 2010-2014 Review

“…Although only one report about this issue has been documented in Korea, 6 other similar reports are available from other countries. [7][8][9][10][11][12][13][14][15][16] Bone pain is the most common complaint, which is aggravated during the night and upon exposure to heat and pressure. Involvement of the skull can lead to headache, usually in the frontotemporal area.…”

“…Involvement of the skull can lead to headache, usually in the frontotemporal area. [6][7][8][9][10][11][12][13][14][15][16] Prompt resolution of bone pain after penicillin therapy is evidence of a syphilitic cause for the bone lesions. A diagnosis of early syphilis is suspected based on the mucocutaneous findings in 76% of patients.…”