The Great Imitator’s Trick on Bones: Syphilitic Osteomyelitis

Jin, Yifan; Zhong, Wenxin; Wang, Xia; Huang, Changzheng; Lu, Yuan

doi:10.2340/actadv.v104.18626

Cited by 2 publications

(1 citation statement)

References 9 publications

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“…Cases of atypical primary syphilis misdiagnosed as pharyngeal lymphoma, tongue cancer, and other types of oral squamous cell carcinomas have been described [39][40][41]; however, the secondary stage of the disease, given the possible involvement of the whole skin area and of other organs, is the one that is most prone to misdiagnosis like palmoplantar psoriasis, psoriasis vulgaris, erythema multiforme, cutaneous lymphoma, and granulomatous diseases of the skin (annular granuloma, sarcoidosis). Moreover, involvement of internal organs with signs and symptoms of osteomyelitis, nephrotic syndrome, retinitis, and others has been reported in secondary syphilis with or without typical cutaneous/mucosal involvement, further complicating the clinical picture [42][43][44][45][46][47]. In regards to neurosyphilis, a recent narrative review revealed a low level of clinical awareness of T. pallidum infection as a possible etiology of various psychiatric disorders including dementia, delirium, depression, mania, personality changes, and psychosis.…”

Section: Discussionmentioning

confidence: 99%

Atypical Manifestations of Syphilis: A 10-Year Retrospective Study

Ciccarese,

Facciorusso,

Mastrolonardo

et al. 2024

JCM

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Background: The incidence of syphilis has increased in high-income countries in the past few decades, especially among men who have sex with men. In the present study, we aimed to analyze the correlations between atypical syphilis manifestations and the demographic, clinical, and laboratory features of patients and to review unusual presentations of syphilis reported in the literature. Methods: We conducted a retrospective analysis of 307 patients with syphilis diagnosed between 1 January 2013 and 31 October 2023 at the sexually transmitted infection (STI) centers of the University of Genoa and University of Foggia with both typical and atypical manifestations of disease. Results: In our series, atypical manifestations were detected in 25.8% of the patients, especially in the secondary stage of the disease. Lesions with annular morphology and lesions presenting as itchy erythematous scaly plaques with a psoriasiform appearance were the most common atypical presentations of secondary syphilis. A statistical analysis revealed that homosexual orientation, syphilis reinfection, and venereal disease research laboratory (VDRL) titers > 1:32 were correlated with atypical manifestations. Conclusions: Our study demonstrates that the spectrum of syphilis manifestations, in all the stages of the disease, is wide; atypical manifestations often pose diagnostic challenges, may delay the provision of appropriate treatment, and facilitate the spread of the infection.

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Section: Discussionmentioning

confidence: 99%

Atypical Manifestations of Syphilis: A 10-Year Retrospective Study

Ciccarese,

Facciorusso,

Mastrolonardo

et al. 2024

JCM

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Novel and characteristic radiological features of neurosyphilis: a case series

Ohira,

Hashimoto,

Kanai

et al. 2024

BMC Neurol

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Background Treponema pallidum can invade the central nervous system (CNS) early in its infection, causing neurosyphilis. Neurosyphilis typically presents with meningovasculitis in the acute or subacute phase, while tabes dorsalis and dementia paralytica are classical conditions in the later stages. However, syphilis is often misdiagnosed as other conditions such as tumors or autoimmune diseases including vasculitis and encephalitis, which is why the condition is known as “The Great Mimicker.” The increasing incidence of syphilis in recent years emphasizes the importance of early diagnosis and treatment; however, its multiple clinical manifestations impose diagnostic challenges for clinicians because it resembles other diseases. In this case series, we present the impressive manifestations of neurosyphilis through three unique radiological presentations. Case presentation Case 1 details optic nerve involvement in an HIV-positive male, where MRI and fundoscopic findings confirmed syphilitic optic neuritis. Case 2 describes a patient in her pregnancy initially suspected of acoustic neuroma on MRI, later diagnosed with syphilitic gumma affecting the inner ear canal. Case 3 is a young male with clinical features mimicking temporal arteritis, ultimately identified as skull osteomyelitis secondarily causing inflammation of the musculus temporalis and meningitis. Conclusions These cases underscore the necessity of considering syphilis in differential diagnoses, given the diversity of its clinical presentations. Radiology plays an important role in avoiding unnecessary interventions. The increasing prevalence of recurrent syphilis imposes diagnostic challenges, emphasizing the importance of the early diagnosis and treatment of neurosyphilis by clinicians.

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The Great Imitator’s Trick on Bones: Syphilitic Osteomyelitis

Abstract: is missing (Short communication)

Cited by 2 publications

References 9 publications

Atypical Manifestations of Syphilis: A 10-Year Retrospective Study

Atypical Manifestations of Syphilis: A 10-Year Retrospective Study

Novel and characteristic radiological features of neurosyphilis: a case series

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