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Eijmael MJP, Bruin RGD, Hira V, Koster T. A peculiar case of syphilis infection: The great imitator is on the rise. IDCases 2022; 28:e01521. [PMID: 35646595 PMCID: PMC9136118 DOI: 10.1016/j.idcr.2022.e01521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/16/2022] [Indexed: 11/21/2022] Open
Abstract
The incidence of syphilis is on the rise worldwide and can pose many diagnostic and therapeutic difficulties for doctors. Given the wide variety of presenting symptoms, syphilis is also known as the great imitator, which in turn frequently leads to a pronounced diagnostic- and therapeutic delay for patients. Here we present a case report of syphilitic uveitis and papillitis accompanied by acute vision loss, a rare presentation of a tertiary syphilis infection that clinically mimicked a giant cell arteritis (GCA) or arteritic anterior ischemic optic neuropathy (AAION). The patient was treated with high-dose intravenous benzyl penicillin after which full vision was restored. By presenting this case, we hope to raise awareness for the increasing incidence of syphilis infections and stress the importance of syphilis testing in patients with otherwise unexplained uveitis.
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Affiliation(s)
- MJP Eijmael
- Department of Internal Medicine, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - RG de Bruin
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - V. Hira
- Department of Medical Microbiology and Infection Prevention, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - T. Koster
- Department of Internal Medicine, Groene Hart Ziekenhuis, Gouda, The Netherlands
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Mignard C, Litrowski N, Carré D, Midhat M, Dupin N, Bravard P. [Syphilitic osteitis in an HIV-negative patient]. Ann Dermatol Venereol 2016; 143:682-686. [PMID: 27020963 DOI: 10.1016/j.annder.2016.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 12/18/2015] [Accepted: 02/12/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Secondary syphilis with skeletal involvement is rare; herein we report a case concerning an HIV-negative patient. PATIENTS AND METHODS During the course of secondary syphilis, a 28-year-old male homosexual, HIV-negative and with no medical history, presented intense and localized headaches persisting despite three weeks of antibiotic therapy. Bone scintigraphy revealed three bone lesions evocative of syphilitic osteitis, for which prolonged antibiotic therapy was instituted. DISCUSSION Few cases of syphilitic osteitis have been described in the recent literature and these are linked to haematogenous diffusion of Treponema pallidum. Skeletal disease is suggested when febrile bone pain is present. Bone scintigraphy remains the best diagnostic tool and treatment comprises prolonged penicillin G or ceftriaxone.
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Affiliation(s)
- C Mignard
- Service de dermatologie, hôpital J.-Monod, groupe hospitalier du Havre, BP 24, 76083 Le Havre, France.
| | - N Litrowski
- Service de dermatologie, hôpital J.-Monod, groupe hospitalier du Havre, BP 24, 76083 Le Havre, France
| | - D Carré
- Service de dermatologie, hôpital J.-Monod, groupe hospitalier du Havre, BP 24, 76083 Le Havre, France
| | - M Midhat
- Service de dermatologie, hôpital J.-Monod, groupe hospitalier du Havre, BP 24, 76083 Le Havre, France
| | - N Dupin
- CNR-Syphilis, laboratoire de dermatologie, hôpital Cochin, bâtiment Gustave-Roussy, 8, rue Méchain, 75014 Paris, France
| | - P Bravard
- Service de dermatologie, hôpital J.-Monod, groupe hospitalier du Havre, BP 24, 76083 Le Havre, France
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Louhab N, Adali N, Kissani N. [Nephrotic syndrome and skin rash]. Nephrol Ther 2014; 10:181-2. [PMID: 24709161 DOI: 10.1016/j.nephro.2013.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 12/04/2013] [Accepted: 12/06/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Nissrine Louhab
- Service de neurologie, hôpital Ibn Tofail, faculté de médecine, université Kadi Ayyad, CHU Mohammed VI, Marrakech, Maroc.
| | - Nawal Adali
- Service de neurologie, hôpital Ibn Tofail, faculté de médecine, université Kadi Ayyad, CHU Mohammed VI, Marrakech, Maroc
| | - Najib Kissani
- Service de neurologie, hôpital Ibn Tofail, faculté de médecine, université Kadi Ayyad, CHU Mohammed VI, Marrakech, Maroc
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[A case of neurological syphilis mimicking Horton's disease and polymyalgia rheumatica]. Ann Dermatol Venereol 2013; 140:619-22. [PMID: 24090892 DOI: 10.1016/j.annder.2013.04.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 03/18/2013] [Accepted: 04/10/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Syphilis has been making a comeback over the last 10 years. Neurosyphilis can occur at any stage of the infection but is difficult to diagnose because of the existence of misleading forms, of which we describe an example below. PATIENTS AND METHODS A 56-year-old woman presented symptoms evoking polymyalgia rheumatica and giant-cell arteritis in a context of ibuprofen treatment for a few weeks. She also had myodesospsia, syphilids and syphilitic roseola, together with laboratory indicators of inflammation. A lumbar puncture revealed lymphocytic meningitis and a positive Treponema Pallidum Haemagglutination Assay (TPHA) for cerebrospinal fluid, thus confirming the diagnosis of neurosyphilis. Moreover, the ophthalmologic examination showed optic neuritis with papilla lesions of syphilitic origin. This was successfully treated with a 3-week course of penicillin G infusions. CONCLUSION Symptoms evocative of Horton's disease and polymyalgia rheumatica can reveal syphilis, a disease dubbed "the great simulator" on account of the variety of clinical forms it can take.
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Zhao YS, Su SI, Lv CX, Zhang XF, Lin L, Sun XG, Lin B, Fu JH. Seroprevalence of hepatitis C, hepatitis B virus and syphilis in HIV-1 infected patients in Shandong, China. Int J STD AIDS 2013; 23:639-43. [PMID: 23033517 DOI: 10.1258/ijsa.2012.011411] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
To determine the seroprevalence of hepatitis C virus (HCV), hepatitis B virus (HBV) and syphilis in HIV-1-infected patients and related risk factors in Shandong province, China, we tested all eligible participants between 2000 and 2010 for the presence of anti-HCV antibody, hepatitis B surface antigen (HBsAg) and non-treponemal antibodies for syphilis after informed consent. Among 2087 HIV-infected patients, anti-HCV antibody was present in 41.2%, HBsAg in 12.6% and rapid plasma reagin (RPR) reactivity in 19.6%. In the multivariate logistic regression model, male gender (adjusted odds ratio [aOR] = 1.41), minority ethnicity (aOR = 1.72), syphilis infection (aOR = 1.40), former paid blood donors (aOR = 3.36), blood transfusion recipients (aOR = 2.91) and injection drug users (aOR = 1.98) were significantly associated with HCV infection. HCV infection (aOR = 1.40) and being men who have sex with men (aOR = 2.38) were significantly associated with syphilis infection. Co-infection with HCV, HBV and syphilis was observed frequently in all described subgroups of HIV infection. The results of this study suggest that it is necessary to screen for these viruses and syphilis in all Chinese HIV-infected patients.
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Affiliation(s)
- Y S Zhao
- Shandong Academy of Medicine of Sciences, Jinan, China
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Turchetti P, Pacella F, Pacella E, Mirisola C, Uccella I. An immunocompetent migrant presenting with neurosyphilis with an unusual unilateral papillitis: a case report. Eur J Med Res 2012; 17:3. [PMID: 22472320 PMCID: PMC3337542 DOI: 10.1186/2047-783x-17-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 02/14/2012] [Indexed: 11/13/2022] Open
Abstract
Unilateral papillitis caused by Treponema pallidum was found in an immunocompetent homosexual patient with severe vision loss who had received previous antibiotics treatment. Syphilis-related ocular manifestation is more common in the early stages of the disease and it can be associated with a central nervous system localization. In this patient, neurosyphilis was diagnosed on the basis of clinical and laboratory findings. Optical examination revealed unilateral papillitis in the left eye and no relative afferent pupillary defects. The patient underwent visual field examinations with conventional perimetry using the 30-2 program of the Humphrey Visual Field Analyzer, which indicated a blind spot enlargement in the left eye. Optical coherence tomography, visual evoked potentials (VEP), and fluorescein angiograms revealed inflammation of the optic nerve head with edematous and blurred margins. A reactive T. pallidum hemagglutination assay with low rapid plasma reagin (RPR) serum titer was performed; an HIV antibody test and MRI of the orbits and head with contrast gave negative results. Resolution of the ocular inflammation after intravenous penicillin treatment was obtained. The reported case illustrates the importance of early recognition of this treatable disease. The rise of syphilis, especially in urban areas, necessitates a high level of suspicion when dealing with patients with intraocular inflammation of unknown origin. Lues serology should be incorporated into routine laboratory diagnostics to aid in the detection of such cases. Considering the re-emergence of syphilis, screening of migrants from countries with high syphilis seroprevalences should be recommended.
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Affiliation(s)
- Paolo Turchetti
- National Institute for Health, Migration and Poverty (INMP/NIHMP), Rome, Italy
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Liu ZY, Zhang Y, Qiu KF, Du SX. Osteomyelitis as the only manifestation of late latent syphilis: case report and literature review. Int J STD AIDS 2011; 22:353-5. [PMID: 21680676 DOI: 10.1258/ijsa.2011.010387] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Bone infection, particularly of the skull and the long bones of the legs and arms, despite being a common characteristic of tertiary stage syphilis and congenital syphilis in the past, is seldom encountered clinically due to effective antibiotic therapy. We report a case of a 62-year-old man who presented with one-month acute pain in the left leg. Treponema pallidum particle agglutination test was positive, and radiography showed a pathological fracture of the left tibiofibula. Surgical debridement and biopsy of the bone marrow were performed and a pathological diagnosis of syphilis osteomyelitis was entertained. The patient's symptoms resolved completely after a six-week course of penicillin. We identified 17 previously published cases of bone lesions of syphilis, eight of which had syphilitic osteomyelitis, seven were syphilitic osteitis and two had syphilitic periostitis. We suggest that bone lesions such as osteomyelitis caused by syphilis can be the only manifestation of late latent syphilis.
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Affiliation(s)
- Z-Y Liu
- Department of Orthopaedics, the First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, China
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Payet J, Seror R, Hanss J, Clerc D, Miceli C, Pavy S, Le Pajolec C, Mariette X. Cervical syphilitic spondylodiscitis associated with neurosyphilis. Rheumatology (Oxford) 2011; 50:1723-5. [PMID: 21622520 DOI: 10.1093/rheumatology/ker185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
After reaching an all time low at the turn of the millennium in several industrialized countries, the syphilis incidence is rising again, perhaps as a consequence of unsafe sexual behavior in response to improved antiretroviral therapeutic options for HIV. Since the beginning of the HIV pandemic, numerous reports on the various aspects of the interaction between syphilis and HIV have been published. Controversies persist on many issues of the management of coinfected patients. This contribution presents a critical appraisal of the available literature. Few large-scale, properly designed, controlled studies have compared syphilis baseline presentation and treatment response according to HIV status. Among the weakness are (1) high rates of patients lost to follow-up, (2) lack of long-term follow-up, (3) lack of gold standard criteria for treatment response, (4) small sample size, and (5) lack of stratification according to syphilis stage, ongoing antiretroviral treatment, CD4 cell count and HIV viral load. From the available data, and given the ever-possible publication bias, we conclude that if HIV has an effect on the course of syphilis, it is small and clinically manageable in most cases. The controversial issues discussed should furnish the rational for clinical research during the forthcoming decade.
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Vargas-Hitos JA, Zamora-Pasadas M, Manzano-Gamero V, Hidalgo-Tenorio C. [Lower limb bone pain as clinical onset of secondary syphilis]. Enferm Infecc Microbiol Clin 2010; 28:750-1. [PMID: 20646791 DOI: 10.1016/j.eimc.2010.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 02/21/2010] [Accepted: 03/03/2010] [Indexed: 10/19/2022]
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Tieulié N, Blanchouin E, Queyrel V, Demonchy E, Schneider-Lise B, Fuzibet JG, Cassoux N. Trente ans de mariage : ça se fête ! Rev Med Interne 2009; 30:896-9. [DOI: 10.1016/j.revmed.2009.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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