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Traczuk A, Chetrit DA, Balasubramanya R, Nwaoduah N, Lee JB, Spacek LA, Loizidis G. Musculoskeletal manifestations of syphilis in adults: secondary syphilis presenting with ankle inflammatory arthritis and bone involvement with calvarial and sternal lesions. What the rheumatologist needs to know. Clin Rheumatol 2023; 42:1195-1203. [PMID: 36454341 DOI: 10.1007/s10067-022-06458-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
Although the incidence of syphilis reached a historic low in 2000, the number of incident cases has since increased in men and women across the USA. In 2019, men who have sex with men (MSM) accounted for 57% of all primary and secondary (P&S) syphilis cases, and about half of MSM with P&S syphilis are living with human immunodeficiency virus (HIV) infection. Days after infection, Treponema pallidum disseminates and invades tissues distant from the site of inoculation. Once the spirochete disseminates, the host develops an inflammatory response; diagnosis requires a high level of suspicion since syphilis may affect the skin, musculoskeletal, cardiovascular, and central nervous systems. We report a 61-year-old man with virally suppressed HIV infection who presented with polyarthralgia, chest pain, and weight loss, diagnosed with secondary syphilis, manifesting with ankle inflammatory arthritis and bone involvement, of the calvarium and manubrium. Early and late syphilis in adults can manifest with articular and periarticular pathologies, including inflammatory arthritis, tenosynovitis, periostitis, and myositis. Higher clinical suspicion is needed for prompt diagnosis of syphilis in patients who are at risk and suspected of having an autoimmune disease. This report includes a review of the musculoskeletal manifestations of syphilis.
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Affiliation(s)
- Ashley Traczuk
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - David Alexandre Chetrit
- Department of Medicine, Division of Rheumatology, University of California, Los Angeles, CA, USA
| | - Rashmi Balasubramanya
- Department of Radiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nneamaka Nwaoduah
- Department of Pathology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jason B Lee
- Department of Dermatology & Cutaneous Biology, Thomas Jefferson University, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lisa A Spacek
- Department of Medicine, Division of Infectious Diseases, Thomas Jefferson University, Philadelphia, PA, USA
| | - Giorgos Loizidis
- Department of Medicine, Division of Rheumatology, Thomas Jefferson University, 211 S 9th Street, Suite 210, Philadelphia, PA, 19107, USA.
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Inayat F, Almas T, Bokhari SRA, Muhammad A, Sharshir MA. Membranous Glomerulonephritis as an Uncommon Presentation of Secondary Syphilis: A Reminder on Therapeutic Decision-Making in Clinical Practice. J Investig Med High Impact Case Rep 2021; 8:2324709620967212. [PMID: 33078640 PMCID: PMC7594254 DOI: 10.1177/2324709620967212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Membranous glomerulonephritis is one of the common causes of nephrotic syndrome
in the adult population. It is idiopathic in the majority of patients, but the
secondary forms can be seen in the setting of autoimmune disease, cancer,
infection, and following exposure to certain medications. However, subclinical
syphilis-related membranous nephropathy remains a particularly rare
clinicopathologic entity in modern times. In this article, we chronicle an
interesting case of latent syphilis masquerading as membranous
glomerulonephritis, which resolved with benzathine penicillin without requiring
immunosuppressive treatment. We further supplement this paper with a concise
review of the relevant literature that delineates the utility of appropriate
antibiotic therapy in the management of luetic membranous nephropathy.
Clinicians should remain cognizant of secondary syphilis while evaluating
patients for possible glomerulonephritis or those presenting with proteinuria.
Additionally, patients with hepatitis B, hepatitis C, and human immunodeficiency
virus infections are not infrequently coinfected with Treponema
pallidum. Therefore, a high index of suspicion for systemic
manifestations of syphilis such as nephrotic syndrome is warranted in the
setting of a coinfection. Prompt diagnosis and treatment of syphilis may result
in resolution of proteinuria, without the need for standard immunosuppressive
therapy commonly used in clinical practice.
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Affiliation(s)
- Faisal Inayat
- Allama Iqbal Medical College, Lahore, Punjab, Pakistan
| | - Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Aun Muhammad
- Allama Iqbal Medical College, Lahore, Punjab, Pakistan
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Kaynar K, Güvercin B, Mungan S, Ulusoy Ş. Don't forget syphilis in membranous nephropathy before immunosuppressants: Latent syphilis in a patient with proteinuria. Nefrologia 2020; 40:681-682. [PMID: 32144011 DOI: 10.1016/j.nefro.2019.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/14/2019] [Accepted: 12/09/2019] [Indexed: 10/24/2022] Open
Affiliation(s)
- Kubra Kaynar
- Department of Nephrology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey.
| | - Beyhan Güvercin
- Department of Nephrology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Sevdegül Mungan
- Department of Pathology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Şükrü Ulusoy
- Department of Nephrology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
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Liu X, Zhang W, Liu Y, Xu M. A Case of Annular Elastolytic Giant Cell Granuloma Associated with Syphilis. Case Rep Dermatol 2018; 10:158-161. [PMID: 30022935 PMCID: PMC6047546 DOI: 10.1159/000489910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/04/2018] [Indexed: 11/25/2022] Open
Abstract
Annular elastolytic giant cell granuloma (AEGCG) is a rare granulomatous skin disease characterized by annular patches with slightly raised borders, hypopigmented and/or atrophic centers found mainly on sun-exposed skin. Histologically, it is characterized by phagocytosis of elastic fibers by multinucleated giant cells. The pathogenesis of the disease is unclear. We report a case of 55-year-old man with AEGCG in association with syphilis, whose condition improved when hydroxychloroquine sulfate and topical tacrolimus were administered over a 2-month period.
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Affiliation(s)
- Xiaoping Liu
- Department of Mycology, Shanghai Skin Disease Hospital, Shanghai, China
| | - Wei Zhang
- Department of Cosmetology, Shanghai Skin Disease Hospital, Shanghai, China
| | - Yeqiang Liu
- Department of Dermatopathology, Shanghai Skin Disease Hospital, Shanghai, China
| | - Mingyuan Xu
- Department of Dermatopathology, Shanghai Skin Disease Hospital, Shanghai, China
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