Juan David Serrano Alonso (Madrid / ES), Belén Pastor Romero (Cuenca / ES), Eva García Jarabo (Madrid / ES), Jorge Gómez Alcaraz (Madrid / ES), Alba Gómez Sánchez (Madrid / ES), Jaime Lora Tamayo (Madrid / ES)
Abstract text (incl. references and figure legends)
Case history
A 45-years-old male with constant bilateral pretibial pain for over a month resistant to analgesia that woke him at night. The patient reported treated syphilis infection after risky sexual contact seven years ago.
Clinical findings
The patient showed anorexia and pain in the right hand and both feet.
Investigation/Results
Initial radiographs showed cortical osteolytic lesions in both tibias and phalanges of the first fingers. MRI and scintigraphy revealed multiple aggressive-looking subcortical lesions in clavicle, tibias and phalanges, that, along with de 7-mm nodule in the RSL evidenced in the CT scan, reaffirmed the suspicion of a bronchogenic tumor metastasis. However, PET-CT suggested inflammatory-infectious etiology, with multiple focal bone deposits in the lower limbs. A biopsy of the pretibial lesion was performed. Treponemal test and RPR for syphiles were both positives.
Diagnosis
Latent syphilis and diffuse periostitis.
Therapy and Progressions
Parenteral penicillin treatment was started, with progressive symptomatic and radiological improvement. Eighteen months after starting treatment, the patient remains asymptomatic.
Comments
Bone involvement in secondary syphilis is an uncommon manifestation that usually appears as periostitis, osteitis or osteomyelitis. It frequently affects the long bones of the lower limbs and the skull. Its usual lytic and multifocal appearance resemble primary or metastatic malignant lesions in radiological images and requiere a differential diagnosis. Diagnosis is based on history of syphilis, imaging tests (scintigraphy and PET-CT) and treponemal tests. Penicillin treatment usually improves symptoms and clears bone lesions within weeks.
References
Park, K.H., Lee, M.S., Hong, I.K., Sung, J.Y., Choi, S.H., Park, S.O., Shin, M.J., Chung, H.W., Lee, S.H. (2014). Bone involvement in secondary syphilis: a case report and systematic review of the literature. Sexually transmitted diseases, 41 (9), 532-537.
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