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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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Ao X, Chen JH, Kata P, Kanukuntla A, Bommu V, Rothberg M, Cheriyath P. The Great Impostor Did It Again: Syphilitic Arthritis. Cureus 2021; 13:e17344. [PMID: 34567885 PMCID: PMC8451258 DOI: 10.7759/cureus.17344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/05/2022] Open
Abstract
Syphilis-related bone and joint involvement is commonly found in congenital form, but it can also be seen in adults with acquired syphilis as a rare sequela of infectious syphilis. We report a case of syphilitic arthritis where the patient presented with multiple problems over the course of several visits and was eventually diagnosed with tertiary syphilis as the source of his musculoskeletal complaints. The clinical manifestations of syphilis can be diverse and challenging, as evidenced by our case. Unusual clinical manifestations might be seen in syphilis, and clinicians may not be familiar with these clinical presentations while diagnosing. Being aware of arthropathy in syphilis and including it in the differential diagnoses will help improve patient outcomes and avoid unfavorable consequences, particularly in the high-risk group.
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Affiliation(s)
- Xue Ao
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| | - Jia Hong Chen
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| | - Priyaranjan Kata
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| | - Anish Kanukuntla
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| | - Veera Bommu
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| | - Michael Rothberg
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| | - Pramil Cheriyath
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
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Adverse childhood experiences and their effect on the orthopaedic surgery patient. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brochard J, Khatchatourian L, Woaye-Hune P, Biron C, Lefebvre M, Denis-Musquer M, Grange P, Dupin N, Raffi F. Immune reconstitution inflammatory syndrome presenting as secondary syphilis with polymorphous erythema and knee arthritis. J Eur Acad Dermatol Venereol 2017; 31:e381-e382. [DOI: 10.1111/jdv.14196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J. Brochard
- Infectious Diseases Department; University Hospital Hotel-Dieu; Nantes University; Nantes France
| | - L. Khatchatourian
- Infectious Diseases Department; University Hospital Hotel-Dieu; Nantes University; Nantes France
| | - P. Woaye-Hune
- Infectious Diseases Department; University Hospital Hotel-Dieu; Nantes University; Nantes France
| | - C. Biron
- Infectious Diseases Department; University Hospital Hotel-Dieu; Nantes University; Nantes France
| | - M. Lefebvre
- Infectious Diseases Department; University Hospital Hotel-Dieu; Nantes University; Nantes France
| | - M. Denis-Musquer
- Department of Pathology; University Hospital Hotel-Dieu; Nantes University; Nantes France
| | - P. Grange
- Faculté de Médecine; INSERM; Institut Cochin U1016; Laboratoire de Dermatologie-CNR Syphilis and AP-HP; Groupe Hospitalier Paris Centre Cochin-Hôtel Dieu-Broca; Service de Dermatologie-Vénéréologie; Université Sorbonne Paris Descartes; Paris France
| | - N. Dupin
- Faculté de Médecine; INSERM; Institut Cochin U1016; Laboratoire de Dermatologie-CNR Syphilis and AP-HP; Groupe Hospitalier Paris Centre Cochin-Hôtel Dieu-Broca; Service de Dermatologie-Vénéréologie; Université Sorbonne Paris Descartes; Paris France
| | - F. Raffi
- Infectious Diseases Department; University Hospital Hotel-Dieu; Nantes University; Nantes France
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Kouassi Djaha JM, Maisonneuve L, de Bandt M. Syphilis, a curable cause of acute polyarthritis. Scand J Rheumatol Suppl 2016; 45:336-7. [DOI: 10.3109/03009742.2015.1111411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- JM Kouassi Djaha
- Department of Rheumatology, Robert Ballanger Hospital, Aulnay sous Bois, France
| | - L Maisonneuve
- Department of Medical Biology, Robert Ballanger Hospital, Aulnay sous Bois, France
| | - M de Bandt
- Department of Rheumatology, Robert Ballanger Hospital, Aulnay sous Bois, France
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Zhu K, Zhou Q, Han R, Cheng H. Acute monoarthritis in a delayed diagnosis of syphilis patient with persistent rupioid psoriasis-like lesions. BMC Infect Dis 2012; 12:338. [PMID: 23216913 PMCID: PMC3524466 DOI: 10.1186/1471-2334-12-338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 11/29/2012] [Indexed: 12/02/2022] Open
Abstract
Background The incidence of syphilis is increasing in many parts of the world. Clinicians may have limited experience in the diagnosis when the clinical appearance is unusual. If early diagnosis is not made and prompt treatment not given, then the disease may remain quiescent until more serious symptoms or systemic involvement develops. Case presentation We report the first case of a delayed diagnosis of syphilis with a ten-year history of persistent rupioid psoriasis-like lesions. Acute monoarthritis and high fever together with aggravation of skin lesions led to a careful clinical examination. Skin biopsies demonstrated syphilis spirochetes on immunohistochemical stain, and syphilis serological titers were positive. Standard treatment with benzathine penicillin brought a partial and transient improvement. A complete clinical and serological resolution of the disease was achieved by a prolonged and repeated penicillin treatment combined with methylprednisolone. A 7-year follow-up of the patient proved a full recovery. Conclusion Our case highlights the fact that clinical signs of syphilis can be diverse and complicated. Unusual clinical manifestations can happen in an immunocompetent individual. Treatment strategy may need to be adjusted in a difficult case.
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Affiliation(s)
- Kejian Zhu
- Department of Dermatology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No, 3 Qingchun Road East, Hangzhou, Zhejiang, People's Republic of China
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