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Traczuk A, Chetrit DA, Balasubramanya R, Nwaoduah N, Lee JB, Spacek LA, Loizidis G. Musculoskeletal manifestations of syphilis in adults: secondary syphilis presenting with ankle inflammatory arthritis and bone involvement with calvarial and sternal lesions. What the rheumatologist needs to know. Clin Rheumatol 2023; 42:1195-1203. [PMID: 36454341 DOI: 10.1007/s10067-022-06458-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
Although the incidence of syphilis reached a historic low in 2000, the number of incident cases has since increased in men and women across the USA. In 2019, men who have sex with men (MSM) accounted for 57% of all primary and secondary (P&S) syphilis cases, and about half of MSM with P&S syphilis are living with human immunodeficiency virus (HIV) infection. Days after infection, Treponema pallidum disseminates and invades tissues distant from the site of inoculation. Once the spirochete disseminates, the host develops an inflammatory response; diagnosis requires a high level of suspicion since syphilis may affect the skin, musculoskeletal, cardiovascular, and central nervous systems. We report a 61-year-old man with virally suppressed HIV infection who presented with polyarthralgia, chest pain, and weight loss, diagnosed with secondary syphilis, manifesting with ankle inflammatory arthritis and bone involvement, of the calvarium and manubrium. Early and late syphilis in adults can manifest with articular and periarticular pathologies, including inflammatory arthritis, tenosynovitis, periostitis, and myositis. Higher clinical suspicion is needed for prompt diagnosis of syphilis in patients who are at risk and suspected of having an autoimmune disease. This report includes a review of the musculoskeletal manifestations of syphilis.
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Affiliation(s)
- Ashley Traczuk
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - David Alexandre Chetrit
- Department of Medicine, Division of Rheumatology, University of California, Los Angeles, CA, USA
| | - Rashmi Balasubramanya
- Department of Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nneamaka Nwaoduah
- Department of Pathology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jason B Lee
- Department of Dermatology & Cutaneous Biology, Thomas Jefferson University, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lisa A Spacek
- Department of Medicine, Division of Infectious Diseases, Thomas Jefferson University, Philadelphia, PA, USA
| | - Giorgos Loizidis
- Department of Medicine, Division of Rheumatology, Thomas Jefferson University, 211 S 9th Street, Suite 210, Philadelphia, PA, 19107, USA.
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Cook OM, Knafo J, Bhaskar R, Salhab M, Nguyen H. Secondary Syphilis Presenting as Erythema Multiforme in the Setting of AIDS and Psoriasis. Cureus 2022; 14:e29110. [PMID: 36259021 PMCID: PMC9559528 DOI: 10.7759/cureus.29110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/13/2022] [Indexed: 11/12/2022] Open
Abstract
Syphilis is a highly infectious sexually transmitted infection (STI) with a multitude of presentations. The disease is known as "the great imitator" as it often presents as other chronic dermatoses, leading to a difficult and delayed diagnosis. Here, we describe the case of a 17-year-old Vietnamese male from Dong Nai Province who was initially diagnosed with psoriasis. However, upon further investigation, he was found to have concurrent secondary syphilis and psoriasis complicated by an undiagnosed human immunodeficiency virus (HIV) infection which presented clinically as generalized erythema multiforme (EM). The patient demonstrated significant improvement after being treated for syphilis and psoriasis, and he was subsequently referred to an infectious disease specialist for treatment of the underlying HIV infection.
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Collot R, Renaud A, Morcel P, Neel A, Desprets M, Forestier A. [Arthralgia and fever in a 55 year-old woman]. Rev Med Interne 2021; 42:811-813. [PMID: 34756610 DOI: 10.1016/j.revmed.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/09/2021] [Indexed: 10/20/2022]
Affiliation(s)
- R Collot
- Service de médecine interne, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France.
| | - A Renaud
- Service de médecine interne, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - P Morcel
- Service de médecine interne, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - A Neel
- Service de médecine interne, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - M Desprets
- Service de médecine interne, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France; Service de médecine interne, centre hospitalier, 1, rue Marengo, 49325 Cholet, France
| | - A Forestier
- Groupe hospitalier mutualiste de Grenoble, 8, rue du Docteur-Calmette, 38000 Grenoble, France
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Kalogeropoulos D, Asproudis I, Stefaniotou M, Moschos M, Gartzonika C, Bassukas I, Konitsiotis S, Milionis H, Gaitanis G, Malamos K, Kalogeropoulos C. Spirochetal uveitis: Spectrum of clinical manifestations, diagnostic and therapeutic approach, final outcome and epidemiological data. Int Ophthalmol 2021; 41:4111-4126. [PMID: 34297303 DOI: 10.1007/s10792-021-01984-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/16/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Analysis of cases with spirochetal uveitis related to spirochetes in a tertiary referral academic center. METHODS Retrospective study of patients diagnosed with uveitis attributed to Treponema pallidum, Leptospira spp. and Borrelia burgdorferi from June 1991 until December 2019. RESULTS A total of 57 cases of spirochetal uveitis (22 patients with T. pallidum, 26 with Leptospira spp., and 9 with B. burgdorferi) that consisted 1% of the overall number of uveitics were recorded. All these cases presented with a wide spectrum of clinical presentations (anterior uveitis, posterior uveitis, panuveitis, vasculitis, papillitis, and in some rare cases concomitant posterior scleritis). The treatment included mainly penicillin or doxycycline, while corticosteroids were administered systematically in some cases with Borrelia or Leptospira infection. The final visual outcome was favorable (> 6/10 in Snellen visual acuity) in approximately 76% of our patients. CONCLUSION Despite being rare, spirochetal uveitis can be detrimental for the vision and must always be included in the differential diagnosis.
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Affiliation(s)
- Dimitrios Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece.
| | - Ioannis Asproudis
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece
| | - Maria Stefaniotou
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece
| | - Marilita Moschos
- 1St Department of Ophthalmology, General Hospital of Athens G. Gennimatas, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantina Gartzonika
- Laboratory of Microbiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis Bassukas
- Department of Skin & Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Spiros Konitsiotis
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Haralampos Milionis
- 1St Division of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgios Gaitanis
- Department of Skin & Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantinos Malamos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece
| | - Chris Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavros Niarchos Ave, 45500, Ioannina, Greece
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