The disappearance of femoral head and neck resulting from extensive bone defect caused by secondary syphilis: a case report and literature review

Abstract

BackgroundTreponema Pallidum (TP), the pathogen of syphilis, commonly infects bones in cases of congenital and tertiary syphilis, but it is rare in the primary and secondary stages. With its mild symptoms and rare clinical findings, it might be easy to dismiss the diagnosis of early syphilis. Usually, effective results can be achieved after the conventional strategy of antibiotic treatments, mainly penicillin. To our knowledge, our case is so far the most serious reported case of destructive bone lesion in secondary syphilis, and our treatment for the case is the first strategy using total hip arthroplasty in secondary syphilis.Case presentationWe present the case of a 71-year-old man with local repeated pain and dysfunction in the right hip. Radiologic examinations showed the disappearance of the ipsilateral femoral head and neck. After excluding the aetiologies of cancer metastasis and tuberculosis, we confirmed the diagnosis of syphilitic arthritis. The patient received the medical treatment of antibiotics and the surgical treatment of total hip arthroplasty. At the follow-up of 1, 3, and 5.5 years after the operation, the patient presented with a pain-free and functional hip prosthesis without local signs of infection and loosening.ConclusionsThis report highlights the difficulties of early diagnosis of secondary syphilis with bone involvement. Bone defect of the femur with secondary syphilis, especially at the proximal femur, was an extremely rare complication in the previous reports. Our case was the first case of a patient who experienced the disappearance of femoral head and neck caused by secondary syphilis. Follow-up after the operation proved the successful treatment of the extensive bone defect of femur by total hip arthroplasty.

A rare case of osteomyelitis and tenosynovitis in secondary syphilis

“…After primary infection, typically resulting in a localized chancre, spirochetemia occurs quickly and organisms may invade nearly any organ system [ 4 ]. T. pallidum has a high affinity for bone, and bacteria are deposited into the bony periosteum, with inflammation extending into the Haversian canals and medulla [ 2 , 5 ]. Bone changes can develop as early as four weeks after primary chancre, and may appear as periostitis, destructive lesions, or a combination of both [ 6 , 7 ].…”

“…Thus, if syphilis is suspected or confirmed in the setting of appropriate symptoms, further evaluation with imaging should be strongly considered. Bone lesions should not be ignored in this setting as advanced destruction can occur without appropriate therapy [ 2 ].…”

“…Based on previous literature, nearly all patients respond well to penicillin therapy and do not require surgical intervention [ 5 , 6 ]. There has been one case requiring total hip arthroplasty due to advanced femoral destruction in the setting of secondary syphilis [ 2 ]. Appropriate duration of antibacterial therapy is unclear, but most have treated for at least several weeks with either intramuscular benzathine penicillin G alone or following intravenous penicillin.…”

“…Bone involvement has been described frequently in congenital syphilis and tertiary syphilis, but is rarely found in secondary syphilis [ 1 ]. A high index of suspicion in patients at risk is necessary, as prompt treatment with appropriate antimicrobials alone is typically successful without requiring surgical intervention [ 2 , 3 ].…”

Is repeated retreatment necessary for HIV‑negative serofast early syphilis patients?

“…Primary syphilis is characterized by more than one chancre and inguinal lymphadenopathy, as well as laboratory confirmation of TP in clinical specimens by RPR and particle agglutination assay for antibody to TP (TPPA), or TP haemagglutination. Secondary syphilis is characterized by skin rash and lymphadenopathy, and confirmed by laboratory testing results for syphilis (12). Early latent syphilis is defined as patients within a year of asymptomatic syphilitic infection supported by positive laboratory testing results and normal cerebrospinal fluid (CSF).…”