ABSTRACT
Bone involvement of syphilis can be observed in tertiary and congenital syphilis. It is infrequent during the secondary stage. The skull is the most affected bone in secondary syphilis, and its most frequent form of presentation is proliferative osteitis. If the skull is affected, headache is usual and can be as intense as in meningitis. Osteolyitic lesions may be seen in complimentary imaging studies, with a moth eaten aspect. These lesions raise concern over a number of differential diagnoses, among which are infectious, inflammatory and neoplastic diseases. The definitive diagnosis is made by bone biopsy of the compromised bone. Molecular techniques in the affected tissues increases diagnostic performance. There is no standardized treatment protocol for syphilis since there are no guidelines available. We report a case of a 19 year old female, presenting with a unique osteolytic lesion in the skull due to secondary syphilis.
El compromiso óseo de la sífilis se observa predominantemente en la sífilis terciaria y en la sífilis congénita, siendo infrecuente durante el estadio secundario. El hueso más afectado durante la sífilis secundaria es el cráneo, siendo la osteítis proliferativa la forma más frecuente de presentación. Cuando afecta la calota, la cefalea es habitual y puede ser tan intensa que se confunde con un proceso meníngeo. En las imágenes se observan lesiones líticas de aspecto apolillado, planteando el diagnóstico diferencial con otras patologías infecciosas, inflamatorias y neoplásicas. El diagnóstico definitivo se realiza por estudio histológico del hueso comprometido. Las técnicas de biología molecular en los tejidos afectados aumentan el rendimiento diagnóstico. No existen protocolos estandarizados para el tratamiento de la sífilis con compromiso óseo. Presentamos el caso clínico de una mujer de 19 años de edad, con una lesión osteolítica única de calota debida a una sífilis secundaria.
Subject(s)
Humans , Female , Young Adult , Osteolysis/microbiology , Osteolysis/pathology , Skull/microbiology , Syphilis/complications , Syphilis/pathology , Osteolysis/drug therapy , Skull/pathology , Magnetic Resonance Imaging , Syphilis/drug therapy , Tomography, X-Ray Computed , Anti-Bacterial Agents/therapeutic useABSTRACT
Patient 28 years old has continued to have a persistent fever (39.2°C), despite ten days treatment by specific antibiotics for bacterial endocarditis associated to a recent claudication of the right lower leg. The persistent fever has motivated a 99mTc-labelled monoclonal anti granulocyte scan which has showed an important uptake in the myocardial septum, and other infection locations in temporal bone and in right tibial arteries. Two days after, a nanocolloids-99mTc WBS showed no uptake in the heart area, a total absence of uptake of the nanocolloids in the bone marrow of right tibia b and cranial SPECT views confirmed the infectious site in the right temporal bone. New antibiotic strategy was adopted successfully associated with surgical amputation of the right lower leg.