Calvarial lytic lesions in neurosyphilis with ocular involvement

Abstract

We report a case of calvarial lytic lesions in neurosyphilis with ocular involvement. A 42-year-old woman with a past medical history of polysubstance abuse presented with recent bilateral vision loss. CT revealed numerous calvarial lytic lesions and multiple myeloma was initially suspected. Syphilis screening with RPR and confirmative CSF studies were positive for active infection. The patient was treated with Penicillin G and demonstrated clinical improvement. The objective of this study was to provide insight into a rare manifestation of syphilis with osseous involvement and encourage further discourse into establishment of standards of care for syphilitic osteomyelitis. There exist no evidence-based guidelines regarding optimal treatment route and duration, role of bone biopsy, determination of therapeutic impact, and threshold for surgical intervention in the management of syphilitic osteomyelitis.

The Great Imitator’s Trick on Bones: Syphilitic Osteomyelitis

“…However, imaging evidence is insufficient to obtain a final diagnosis, because it is not possible to conclude that the bone lesions are caused by syphilis. A bone biopsy may provide diagnostic evidence when Treponema pallidum is detected, while it sometimes reveals no clue, particularly in patients who simultaneously have AIDS ( 6 , 7 ). In addition, despite some recent advances ( 8 ), in vitro cultivation of Treponema pallidum remains a challenge in pathological practice, which prevents bone biopsy from being performed routinely and becoming a gold standard.…”

Ostéomyélite syphilitique chez un patient présentant des céphalées et des lésions lytiques

“…Selon une revue systématique plus récente sur les manifesta tions osseuses associées à la syphilis secondaire, seulement 36 cas de syphilis secondaire présentant une atteinte osseuse ont été répertoriés de 1964 à 2014 4 . Cela dit, on constate actuel lement une hausse des rapports de cas d'ostéite associée à la syphilis précoce, particulièrement chez les personnes vivant avec le VIH, ce qui semble indiquer que l'ostéite pourrait être une manifestation de la syphilis plus fréquente que ce qu'on décrivait auparavant [5][6][7][8][9] . Il est possible que l'augmentation de la préva lence relative soit une conséquence de l'évolution des tech niques d'imagerie, ainsi que du nombre croissant de personnes vivant avec le VIH.…”

Syphilitic osteomyelitis in a patient with headache and lytic lesions

“…4 An increasing number of case reports of syphilitic osteitis in early syphilis, particularly in people living with HIV, suggests that osteitis may be a more common manifestation of syphilis than previously described. [5][6][7][8][9] The increased relative prevalence is potentially second ary to advanced imaging techniques, as well as the increased number of people living with HIV.…”