Osteitis in the dens of axis caused by Treponema pallidum

BMC Infectious Diseases

Susanne Dam Nielsen³  Michael Kemp⁵  Caroline Ewertsen⁴  Charlotte Winther²  Thilde Fabricius¹ 

[1] Deparment of Infectious Diseases, Odense University Hospital, Rigshospitalet, Denmark;Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Denmark;Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark;Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Denmark;Deparment of Microbiology, SSI, National Institute for Health Data and Disease Control, Copenhagen, Denmark

关键词: PCR;    HIV;    Treponema pallidum;    Osteitis;    Syphilis;   

Others  :  1146637
DOI  :  10.1186/1471-2334-13-347

 received in 2012-08-14, accepted in 2013-07-19,  发布年份 2013

【 摘 要 】

Background

Syphilis has been referred to as “the great imitator” due to its ability to imitate other diseases. Untreated syphilis becomes a systemic infection that can involve almost every organ systems. Treponema pallidum has a high affinity for bone tissue, but osteitis has mainly been described in late stages of the disease. Vertebral involvement is rare, and this is to our knowledge the first case describing syphilitic spondylitis in early acquired syphilis.

Case presentation

We here describe destructive osteitis in the vertebral column as the initial manifestation of early acquired syphilis in a 24-year-old caucasian homosexual male with HIV infection. The diagnosis was reached by universal bacterial PCR and DNA sequencing of the DNA product. It was confirmed by PCR specific for Treponema pallidum, immunohistochemistry and detection of increasing antibody titer.

Conclusions

As syphilis has re-emerged in Western countries and remains a worldwide common disease it is important to have in mind as a causative agent of skeletal symptoms, especially among HIV-infected individuals or men who have sex with men (MSM).

【 授权许可】

   
2013 Fabricius et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Mandell GL, Doulin R, Bennett JE: Principles and practice of infectious diseases. Churchill Livingstone 2009, 2:2768-2783.
• [2]Reynolds F, Wasserman H: Destructive osseus lesions in early syphilis. Arch Intern Med 1942, 69:263-76.
• [3]Liu Z-Y, Du SX, Qui KF, Zhang : Osteomyelitis as the only manifestation of late latent syphilis: case report and literature review. Int J STD AIDS 2011, 22:353-355.
• [4]Mindel A, Tovey SJ, Timmins DJ, Williams P: Primary and secondary syphilis 20 years’ experience. 2. Clinical features. Genitourin Med 1989, 65:1-3.
• [5]EPI-NEWS: SSI, National Institute for Health Data and Disease Control, Copenhagen. 2009. http://www.ssi.dk/Aktuelt/Nyhedsbreve/EPI-NYT/~/media/Indhold/DK%20-%20dansk/Aktuelt/Nyhedsbreve/EPI-NYT/2009/2009%20PDF/EPI-NYT%20-%202009%20-%20uge%2023.ashx webcite
• [6]EPI-NEWS: SSI, National Institute for Health Data and Disease Control, Copenhagen. 2011. http://www.ssi.dk/Aktuelt/Nyhedsbreve/EPI-NYT/2011/Uge%2035a%20-%202011.aspx webcite
• [7]Zetola NM, Klausner JD: Syphilis and HIV Infection: An update. Clin Inf Dis. 2007, 44:1222-8.
• [8]Grarup C, Gleesen AS, Dargis R, Andresen K, Christensen JJ, Kemp M: Infections with betahaemolytic streptococci: Detection by a universal PCR for bacterial DNA and DNA sequencing. Scand J Infect Dis 2008, 40:547-550.
• [9]Thompson R, Preston R: Lesions of the skull in secondary syphilis. Am J Syph Gonnorrhea Vener Dis. 1952, 36:332-41.
• [10]Kandelaki G, Kapila R, Fernandes H: Destructive osteomyelitis associated with early secondary syphilis in an HIV-positive patient diagnosed by Treponema pallidum DNA Polymerase Chain Reaction. AIDS Patient Care STDS 2007, 21:229-33.
• [11]Samarkos M, Giannopoulou C, Karantoni E, Papastamopoulos V, Baraboutis I, Skoutelis A: Syphilitic periostitis of the skull and ribs in a HIV positive patient. Sex Transm Infect 2011, 87:44-45.
• [12]Huang I, Leach JL, Fichtenbaum CJ, Narayan RK: Osteomyelitis of the skull in early-aquired syphilis: Evaluation by MR imaging and CT. Am J Neuroradiology 2007, 28:307-08.
• [13]Hansen K, Hvid-Jakobsen K, Lindewald H, Sørensen PS, Weismann K: Bone lesions in early syphilis detected by bone scintigraphy. Br J Vener Dis 1984, 60:265-8.
• [14]Cronin EB, Williams WH, Tow DE: Radionuclide Imaging in a Case of Tertiary Syphilis Involving Liver and Bones. J Nucl Med 1987, 28:1047-51.
• [15]Savage EJ: Syphilis and Gonorrhoea in men who have sex with men. A European Overview. Euro Surveill 2009, 14:19417.