title: Bone involvement in secondary syphilis: a case report and systematic review of the literature.
abstract: Bone involvement is an unusual manifestation of secondary syphilis, but little information is available in the English-language literature. We carried out a systematic review of the English-language literature from 1964 to 2013, describing cases of secondary syphilis with bone involvement. We also describe a case of secondary syphilis with multiple osteolytic lesions, mimicking metastatic cancer or myeloma, which was included in an analysis of 37 eligible cases of secondary syphilis with bone involvement. Of these 37 patients, 28 (76%) patients were male, and the median age was 32 years (range, 12-64 years). Eleven (30%) patients had human immunodeficiency virus (HIV) infection with a median CD4 lymphocyte count of 343 cells/mm (range, 130-689 cells/mm). The diagnosis of early syphilis was suspected based on mucocutaneous findings in 28 (76%) cases. In the remaining 9 (24%) cases, high titers of nontreponemal serologic tests were the only evidence of early syphilis. The median venereal disease research laboratory (VDRL) titer was 1:64 (range, 1:8-1:320), and median rapid plasma reagin (RPR) titer was 1:64 (range, 1:16-1:512). The bones most often affected were long bones of the limbs (n = 22) and skull (n = 21). The bone lesions were multifocal in 27 (73%) cases and osteolytic in 19 (51%) cases. The treatment of syphilitic bone lesions was medical only in most patients, and prognosis was favorable with high-dose penicillin therapy. Clinical features and outcome between HIV-uninfected and HIV-infected patients were not different. Knowledge of this rare entity may lead to early diagnosis and appropriate management.
authors.affiliation: From the Departments of *Internal Medicine, †Nuclear Medicine, and ‡Pathology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul Republic of Korea; and Departments of §Infectious Diseases and ¶Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Ki-Ho
authors.initials: KH
authors.lastname: Park
authors.forename: Mi Suk
authors.initials: MS
authors.lastname: Lee
authors.forename: Il Ki
authors.initials: IK
authors.lastname: Hong
authors.forename: Ji-Youn
authors.initials: JY
authors.lastname: Sung
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Sang Ok
authors.initials: SO
authors.lastname: Park
authors.forename: Myung Jin
authors.initials: MJ
authors.lastname: Shin
authors.forename: Hye Won
authors.initials: HW
authors.lastname: Chung
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003937:Diagnosis, Differential; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D010019:Osteomyelitis / Q000188:drug therapy* / Q000382:microbiology*; D010401:Penicillin G Benzathine / Q000627:therapeutic use*; D011859:Radiography; D013131:Spine / Q000000981:diagnostic imaging / Q000382:microbiology; D013587:Syphilis / Q000000981:diagnostic imaging / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D010401:Penicillin G Benzathine