Rest pain and leg ulceration due to syphilitic osteomyelitis of the tibia

A skeletal case of hypertrophic osteoarthropathy from the Canary Islands dating from 1000 BP

A left tibia, the distal right tibia, and the proximal four fifths of the right ulna and radius, probably belonging to an adult prehispanic man (antiquity of ≈1000 years BP) were found among commingled bone remains in a collective burial cave of the island of El Hierro, in the Canary Archipelago. All four bones show an intense periosteal bone formation, encrusting the preserved cortical bone of the diaphyses. Differential diagnosis include melorheostosis, syphilis, and leprosy, although the most likely diagnosis is hypertrophic osteoarthropathy, which is usually associated with lung neoplasm or non-malignant diseases leading to chronic hypoxemia. The marked bone proliferation, possibly due to a chronic condition, suggests that possibly the underlying illness was a non-malignant one.

Der lange Weg der Syphilis bis zum Ulcus cruris syphiliticum

Die Syphilis fiel im wahrsten Sinne des Wortes von einem Tag auf den anderen in Europa ein. Sie stellte sich in einer ganz anderen Weise dar, wie wir sie heute kennen. In einer der ersten Beschreibungen von Josef Grünpeck ist die Rede von fürchterlichen schwarzen Zapfen und kleinen Hörnern mit bestialischem Gestank, die im Gesicht hervorwuchsen sowie von grausamen Knochenschmerzen, so dass sich die Kranken den Tod herbeiwünschten. Durch die ständigen Kriegshandlungen, aber ebenso durch die gesellschaftlichen Verhältnisse kam es im 16. Jahrhundert von Spanien her über Neapel zu einer rasant fortschreitenden Epidemie, die schließ-lich ganz Europa überrannte. Die Folge waren grundlegende Einflüsse auf das kulturelle Leben der Menschen in allen Gesellschaftsschichten. Die Ärzte haben sich in einer heute unübersehbaren Literatur mit der Krankheit auseinandergesetzt. Dabei stellt das Blickfeld auf das Ulcus cruris syphiliticum nur einen winzigen Ausschnitt dar.

[Infectious bone diseases]

Bacterial infection of the bone is a severe disease with complications, potentially including long-term physical disability. The diagnosis and therapy of osteomyelitis include several elements: histopathology, microbiology, radiologic imagining, as well as antibiotic and surgical therapy. Histopathologists differentiate between acute osteomyelitis (infiltration of cancellous bone with neutrophil granulocytes); specific osteomyelitis (epithelioid-like granulomatous inflammation, tuberculosis, mycotic infections); primary/secondary chronic osteomyelitis (lymphocytic infiltration); and special forms of chronic osteomyelitis (varying histomorphology, Brodie abscess, SAPHO syndrome). Another important task in the histopathological diagnosis of inflammatory bone diseases is to differentiate osteomyelitis from malignant entities (sarcoma, lymphoma). Therefore, biopsy samples should be of sufficient size for safe diagnosis. Clinical information and imaging as well as interdisciplinary teamwork between radiologists, microbiologists, orthopedic surgeons and pathologists is mandatory to verify these diagnoses.

Osteomyelitis as the only manifestation of late latent syphilis: case report and literature review

Bone infection, particularly of the skull and the long bones of the legs and arms, despite being a common characteristic of tertiary stage syphilis and congenital syphilis in the past, is seldom encountered clinically due to effective antibiotic therapy. We report a case of a 62-year-old man who presented with one-month acute pain in the left leg. Treponema pallidum particle agglutination test was positive, and radiography showed a pathological fracture of the left tibiofibula. Surgical debridement and biopsy of the bone marrow were performed and a pathological diagnosis of syphilis osteomyelitis was entertained. The patient's symptoms resolved completely after a six-week course of penicillin. We identified 17 previously published cases of bone lesions of syphilis, eight of which had syphilitic osteomyelitis, seven were syphilitic osteitis and two had syphilitic periostitis. We suggest that bone lesions such as osteomyelitis caused by syphilis can be the only manifestation of late latent syphilis.