Destructive Osseous Lesions in Early Syphilis

Reynolds, Frank W.; Wasserman, Harry H.

doi:10.1001/archinte.1942.00200140101008

Cited by 46 publications

(32 citation statements)

References 6 publications

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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 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%

Periostitis in Secondary Syphilis: A Place for Bone Scintigraphy

et al. 1985

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“…5 In 1942, a series of 10,000 cases of early syphilis found only 15 cases of destructive bone lesions (0.15%), and of these only 8 had cranial involvement. 6 The incidence of bone disease in early syphilis was confirmed in more recent years. In other retrospective series of 854 patients diagnosed as having secondary syphilis for 20 years, only 2 cases were found (0.2%).…”

Section: Discussionmentioning

confidence: 92%

Polyostotic Osteitis in Secondary Syphilis in an HIV-Infected Patient

Boix

Merino²,

Reus³

et al. 2013

Sexually Transmitted Diseases

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“…First, the most comprehensive study on bone-destructive involvement in early syphilis, which has been widely quoted since its publication in 1942,7 was carried out by Reynolds and Wasserman at Johns Hopkins Hospital between the years of 1919 and 1940. This study reported only 15 cases (0.15%) of bone-destructive lesions out of a total of 10 000 cases of early syphilis, laying down the platform for the conception that bone lesions are extremely rare in early-stage syphilis (primary and secondary).…”

Section: Discussionmentioning

confidence: 99%

Syphilis: an unusual manifestation?

et al. 2014

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Syphilis is a widely investigated infectious venereal disease with varied presentations frequently mimicking other diseases. It progresses in distinct, well-characterised stages: early (primary and secondary), latent, and late (tertiary), each stage having its own unique presentations. However, there has been increasing evidence of atypical presentations. We describe one such presentation of early syphilis in its secondary stage. A man in his late 20s presented with a rash (which is typical of the secondary stage) and with bone pain with multiple lytic lesions (which is rare in the secondary stage but more typical of the tertiary stage). The patient was successfully treated for secondary syphilis. On the basis of our case, and on analysis of other case reports and research of early-stage syphilitic bone involvement, we conclude that the true incidence of bone involvement in early-stage syphilis may be higher than has been previously appreciated, and thus may be under-recognised and underdiagnosed.

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Destructive Osseous Lesions in Early Syphilis

Cited by 46 publications

References 6 publications

Periostitis in Secondary Syphilis: A Place for Bone Scintigraphy

Periostitis in Secondary Syphilis: A Place for Bone Scintigraphy

Polyostotic Osteitis in Secondary Syphilis in an HIV-Infected Patient

Syphilis: an unusual manifestation?

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