title: Forgotten but Not Gone! Syphilis Induced Tenosynovitis.
abstract: Objective. Tenosynovitis, inflammation of a tendon and its synovial sheath, is a rare manifestation of secondary syphilis and if diagnosed early is reversible.Background. A 52-year-old male with past medical history of untreated syphilis presented with gradual onset of swelling and pain of the right fourth metacarpophalangeal joint (MCP). He reported a history of painless penile lesions after having sexual intercourse with a new partner approximately five months ago which was treated with sulfamethoxazole/trimethoprim. An RPR done at that time came back positive with a high titer; however, patient was lost to follow-up. On examination, patient had an edematous, nonerythematous right fourth proximal interphalangeal (PIP) joint. Urgent irrigation, debridement, and exploration of the right hand into the tendon sheath were performed. With his history of syphillis, an RPR was done, which was reactive with a titer of 1 : 64. A confirmatory FTA-ABS test was completed, rendering a positive result. Based on his history of untreated syphilis, dormancy followed by clinical scenario of swelling of the right fourth finger, and a high RPR titer, he was diagnosed with secondary syphilis manifesting as tenosynovitis.
authors.affiliation: CHI Health Creighton University Medical Center, Omaha, NE, USA.
authors.forename: Felicia
authors.identifier: 0000-0002-3197-7944
authors.initials: F
authors.lastname: Ratnaraj
authors.affiliation: CHI Health Creighton University Medical Center, Omaha, NE, USA.
authors.forename: David
authors.initials: D
authors.lastname: Brooks
authors.affiliation: CHI Health Creighton University Medical Center, Omaha, NE, USA.
authors.forename: Mollie
authors.initials: M
authors.lastname: Walton
authors.affiliation: CHI Health Creighton University Medical Center, Omaha, NE, USA.
authors.forename: Arun
authors.initials: A
authors.lastname: Nagabandi
authors.affiliation: CHI Health Creighton University Medical Center, Omaha, NE, USA.
authors.forename: Mahmoud
authors.identifier: 0000-0002-2639-6926
authors.initials: M
authors.lastname: Abu Hazeem