Advertisement

Syphilis-Related Musculoskeletal Manifestations

  • Najia Hajjaj-Hassouni
  • Hanan Rkain
Chapter

Abstract

Syphilis is a chronic sexually transmitted infection due to the spirochetal bacterium Treponema pallidum (TP) subspecies Pallidum, the overall incidence of which is recently increasing among the sexually transmitted diseases. This increase concerns both congenital syphilis (early and late) and acquired syphilis. The natural history of the latter is stereotyped with a three-phase clinical evolution, primary, secondary, and tertiary, and can be also subdivided into early or “infectious syphilis” and late syphilis. This natural history includes not only the central nervous and the cardiovascular systems as well as gummatous infections but also many other sites, among them the musculoskeletal system. Syphilitic musculoskeletal manifestations (MSKM) remain rare. However they should be kept in mind because of the current recrudescence of the disease and because of their frequently misleading expression which contributed, among other syphilitic manifestations, to make the disease earn the name “great simulator.” Syphilitic MSKM are mainly related to the hematogenous dissemination of TP. The main lesions are bone involvement (osteochondritis, periosteitis and osteitis) and joint involvement, the pattern of which is in keeping with the clinical presentation of the disease. However, involvement of muscles, tendons, and their sheaths, as well as bursitis, although rare, has also been reported.

Keywords

Syphilis Musculoskeletal syphilis Chondritis Osteitis Periosteitis Arthritis Muscle Tenosynovitis Treatment 

References

  1. 1.
    WHO: Global health sector strategy on sexually transmitted infections 2016–202. http://apps.who.int/iris/bitstream/handle/10665/246296/WHO-RHR-16.09-eng.pdf?sequence=1. Accessed the 23 Aug 2018.
  2. 2.
    Hook EW 3rd. Syphilis. Lancet. 2017;389:1550–7.CrossRefGoogle Scholar
  3. 3.
    Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N, Stevens G, Gottlieb S, Kiarie J, Temmerman M. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PLoS One. 2015;10(12):e0143304.CrossRefGoogle Scholar
  4. 4.
    Koff AB, Rosen T. Nonvenereal treponematoses: yaws, endemic syphilis, and pinta. J Am Acad Dermatol. 1993;29:519–35.CrossRefGoogle Scholar
  5. 5.
    Colmegna I, Koehler JW, Garry RF, Espinoza LR. Musculoskeletal and autoimmune manifestations of HIV, syphilis and tuberculosis. Curr Opin Rheumatol. 2006;18:88–95.CrossRefGoogle Scholar
  6. 6.
    Mattei PL, Beachkofsky TM, Gilson RT, Wisco OJ. Syphilis: a reemerging infection. Am Fam Physician. 2012;86(5):433–40.PubMedGoogle Scholar
  7. 7.
    Nguyen TQ, Kohn RP, Ng RC, Philip SS, Cohen SE. Historical and current trends in the epidemiology of early syphilis in San Francisco, 1955 to 2016. Sex Transm Dis. 2018;45(9S Suppl 1):S55–62.CrossRefGoogle Scholar
  8. 8.
    Rodríguez-Cerdeira C, Silami-Lopes VG. Congenital syphilis in the 21st century. Actas Dermosifiliogr. 2012;103(8):679–93.CrossRefGoogle Scholar
  9. 9.
    Heston S, Arnold S. Syphilis in children. Infect Dis Clin N Am. 2018;32:129–44.CrossRefGoogle Scholar
  10. 10.
    Schmid G. Economic and programmatic aspects of congenital syphilis prevention. Bull World Health Organ. 2004;82:402–9.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Rasool MN, Govender S. The skeletal manifestations of congenital syphilis. A review of 197 cases. J Bone Joint Surg Br. 1989;71:752–5.CrossRefGoogle Scholar
  12. 12.
    Ghadouane M, Benjelloun BS, Elharim-Roudies L, Jorio-Benkhraba M, El Malki-Tazi A. Bone involvement of early congenital syphilis (about 86 cases). Rev Rhum Mal Osteoartic. 1995;62:457–61. [Article in French].Google Scholar
  13. 13.
    Benyaich A. The bone involvement in early congenital syphilis. Medical Doctorate thesis, 14/2002, Mohammed V University, Rabat, Morocco. [Thesis in French].Google Scholar
  14. 14.
    Stephens JR, Arenth J. Wimberger sign in congenital syphilis. J Pediatr. 2015;167(6):1451.CrossRefGoogle Scholar
  15. 15.
    Austin T, Melhem RE. Pulmonary changes in congenital syphilis. Pediatr Radiol. 1991;21:404–5.CrossRefGoogle Scholar
  16. 16.
    King AJ, Catterall RD. Syphilis of bones. Br J Vener Dis. 1959;35:116–28.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Krüger C, Malleyeck I. Congenital syphilis: still a serious, underdiagnosed threat for children in resource-poor countries. World J Pediatr. 2010;6:125–31.CrossRefGoogle Scholar
  18. 18.
    Martin D, Bertrand J, Mckegney C, Thompson L, Belongia E, Mills W. Congenital syphilis surveillance and newborn evaluation in a low-incidence state. Arch Pediatr Adolesc Med. 2001;155(2):140–4.CrossRefGoogle Scholar
  19. 19.
    Reynolds FW, Wasserman H. Destructive osseous lesions in early syphilis. Arch Intern Med. 1942;69:263–76.CrossRefGoogle Scholar
  20. 20.
    Bezalely S, Jacob G, Flusser G, Ablin J. Syphilis: an unusual manifestation? BMJ Case Rep. 2014:bcr2014204871.Google Scholar
  21. 21.
    Reginato AJ. Syphilitic arthritis and osteitis. Rheum Dis Clin N Am. 1993;19:379–98.Google Scholar
  22. 22.
    Huang I, Leach JL, Fichtenbaum CJ, Narayan RK. Osteomyelitis of the skull in early-acquired syphilis: evaluation by MR imaging and CT. Am J Neuroradiol. 2007;28:307–8.CrossRefGoogle Scholar
  23. 23.
    El Alaoui FM, Birouk N, Slassi I, Jiddane M, Chkili T. Thrombosis of the upper longitudinal sinus and syphilitic cranial osteitis. Rev Neurol (Paris). 1992;148(12):783–5. [Article in French].Google Scholar
  24. 24.
    Gurland IA, Korn L, Edelman L, Wallach F. An unusual manifestation of acquired syphilis. Clin Infect Dis. 2001;32:667–9.CrossRefGoogle Scholar
  25. 25.
    Dismukes WE, Delgado DG, Mallernee SV, Myers TC. Destructive bone disease in early syphilis. JAMA. 1976;236:2646–8.CrossRefGoogle Scholar
  26. 26.
    Kang SH, Park SW, Kwon KY, Hong WJA. Solitary skull lesion of syphilitic osteomyelitis. J Korean Neurosurg Soc. 2010;48(1):85–7.CrossRefGoogle Scholar
  27. 27.
    Strada M, Gariboldi M, Segalini G, Meregaglia D. Secondary syphilis. Localizations in the bones of the skull. Radiol Med. 1987;73:453–4.PubMedGoogle Scholar
  28. 28.
    Kusler J, Arthurs S. Rare case of four osseous lesions of the skull in a patient with secondary syphilis. Case Rep Infect Dis. 2018. Article ID 3148758, 3 pages;  https://doi.org/10.1155/2018/3148758.CrossRefGoogle Scholar
  29. 29.
    Etienne M, Bencteux P, Gueit I, Abboud P, Caron F. Déjà vu in the catacombs: skull syphilitic osteitis. Lancet Infect Dis. 2008;8:455.CrossRefGoogle Scholar
  30. 30.
    Denes E, Pinet P, Ducroix-Roubertou S. Syphilitic periosteitis. Eur J Intern Med. 2009;20:e78–9.CrossRefGoogle Scholar
  31. 31.
    Liang X, Liu T, Yuan C, Wang W, Liang P. The disappearance of femoral head and neck resulting from extensive bone defect caused by secondary syphilis: a case report and literature review. BMC Musculoskelet Disord. 2018;19:251–61.CrossRefGoogle Scholar
  32. 32.
    Aderinto J, Knight D, Keating JF. Early syphilis: a cause of mono-arthritis of the knee. Ann R Coll Surg Engl. 2008;90:W1.CrossRefGoogle Scholar
  33. 33.
    Shatley MJ, Walker BL, McMurray RW. Lues and lupus: syphilis mimicking systemic lupus erythematosus. Lupus. 2001;10:299–303.CrossRefGoogle Scholar
  34. 34.
    Skillrud DM, Bunch TW. Secondary syphilis mimicking systemic lupus erythematosus. Arthritis Rheum. 1983;26(12):1529–31.CrossRefGoogle Scholar
  35. 35.
    Kazlow PG, Beyer B, Brandeis G. Polyarthritis as the initial symptom of secondary syphilis: case report and review. Mt Sinai J Med. 1989;56(1):65–7.PubMedGoogle Scholar
  36. 36.
    Duarte JA, Henriques CC, Sousa C, Alves JD. Lupus or syphilis? That is the question! BMJ Case Rep. 2015:1–6.  https://doi.org/10.1136/bcr-2015-209824.Google Scholar
  37. 37.
    Gerster JC, Weintraub A, Vischer TL, Fallet GH. Secondary syphilis revealed by rheumatic complaints. J Rheumatol. 1977;4:197–200.PubMedGoogle Scholar
  38. 38.
    Reginato AJ, Schumacher HR, Jimenez S, Maurer K. Synovitis in secondary syphilis. Clinical, light and electron microscopic studies. Arthritis Rheum. 1979;22:170–6.CrossRefGoogle Scholar
  39. 39.
    Reginato AJ, Ferreiro-Seoane JL, Falasca G. Unilateral sacroiliitis in secondary syphilis. J Rheumatol. 1988;15:717–9.PubMedGoogle Scholar
  40. 40.
    Durston JH, Jefferiss FJ. Syphilitic myositis. A case of myositis associated with secondary syphilis. Br J Vener Dis. 1975;51(2):141–2.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Yacyshyn E, Chiowchanwisawakit P, Emery DJ, Hamandas J, Resch L, Taylor G. Syphilitic myositis: a case-based review. Clin Rheumatol. 2011;30:729–33.CrossRefGoogle Scholar
  42. 42.
    Nord J, Elemam A, Mandell W. Myositis as an unusual presentation of secondary syphilis. South Med J. 2010;103(8):807–8.CrossRefGoogle Scholar
  43. 43.
    Nelson TV, Blaceri S, Biederman JI. Rhabdomyolysis and acute renal failure with syphilitic myositis. Kidney Int. 2016;89(5):1169.CrossRefGoogle Scholar
  44. 44.
    McPhee SJ. Secondary syphilis: uncommon manifestations of a common disease. West J Med. 1984;140(1):35–42.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Ratnaraj F, Brooks D, Walton M, Nagabandi A, Abu Hazeem M. Forgotten but not gone! syphilis induced tenosynovitis. Case Rep Infect Dis. 2016;7420938  https://doi.org/10.1155/2016/7420938.CrossRefGoogle Scholar
  46. 46.
    Rosa-Gonçalves D, et al. Unusual presentations and pitfalls of secondary syphilis: periosteitis, tenosynovitis and hepatic abnormalities. Reumatol Clin. 2017;  https://doi.org/10.1016/j.reuma.2017.03.009.CrossRefGoogle Scholar
  47. 47.
    James WD, Berger TG, Elston DM. Andrews’ diseases of the skin, 12th ed. 2016;18:343–358.e3.Google Scholar
  48. 48.
    Cheikhrouhou AL, Chiraz A, Ben Hadj YC, Tekaya R, Chaabouni L, Rafik ZR. Osteoarticular manifestations of late congenital syphilis. Presse Med. 2008;37(10):1507–11. [Article in French].CrossRefGoogle Scholar
  49. 49.
    Eulry F, Doury P. Treponematosis osteo-articular manifestations. EMC (Elsevier Masson SAS, Paris), Appareil locomoteur, 14–019-A-10, 1998:6p [in French].Google Scholar
  50. 50.
    Banal F, Ndiaye AR, Lechevalier D. Treponematosis osteo-articular involvement. EMC Appareil locomoteur Paris. 2010;5(2):1–7. [in French].CrossRefGoogle Scholar
  51. 51.
    Schmid FR. In: Mc Carthy Jr DJ, editor. Arthritis and allied conditions: Henry Kimpton publishers; 1979. p. 1373–5.Google Scholar
  52. 52.
    Resnick D. Neuropathic osteoarthropathy. In: Resnick D, editor. Diagnosis of bone and joint disorders. 4th ed. Philadelphia: WB Saunders; 2002. p. 3564–95.Google Scholar
  53. 53.
    Allali F, Rahmouni R, Hajjaj-Hassouni N. Tabetic arthropathy. A report of 43 cases. Clin Rheumatol. 2006;25:858–60.CrossRefGoogle Scholar
  54. 54.
    Schotanus M, Dorleijn DM, Hosman AJ, Huits RM, Koopmans PP, Galama JM. A patient with multifocal tabetic arthropathy: a case report and review of literature. Sex Transm Dis. 2013;40(3):251–7.CrossRefGoogle Scholar
  55. 55.
    Steindler A. Tabetic arthropathies. JAMA. 1931;96:250–6.CrossRefGoogle Scholar
  56. 56.
    Wolters EC. Neurosyphilis: a changing diagnostic problem? Eur Neurol. 1987;26:23–8.CrossRefGoogle Scholar
  57. 57.
    Stokes JH, Beerman H, Ingraham NR. Modern clinical syphilology. Diagnosis, treatment, case study. 3rd ed. Philadelphia: WB Saunders; 1944.Google Scholar
  58. 58.
    Martinet P, M’Bappe P, Lebreton C, Heinzleff O, Sibony M, Papeix C, Judet T. Neuropathic arthropathy: a forgotten diagnosis? Two recent cases involving the hip. Rev Rhum Engl Ed. 1999;66(5):284–7.PubMedGoogle Scholar
  59. 59.
    Rothschild BM, Behnam S. The often overlooked digital tuft: clues to diagnosis and pathophysiology of neuropathic disease and spondyloarthropathy. Ann Rheum Dis. 2005;64:286–90.CrossRefGoogle Scholar
  60. 60.
    Bai Y, Niu F, Liu L, Sha H, Wang Y, Zhao S. Tertiary syphilis in the lumbar spine: a case report. BMC Infect Dis. 2017;17:513.CrossRefGoogle Scholar
  61. 61.
    Johns D. Syphilitic disorders of the spine. Report of two cases. J Bone Joint Surg Br. 1970;52(4):724–31.CrossRefGoogle Scholar
  62. 62.
    Griffiths RW, Rose MJ. Acute vertebral collapse and cauda equina compression in tertiary syphilis. J Neurol Neurosurg Psychiatry. 1975;38(6):558–60.CrossRefGoogle Scholar
  63. 63.
    Kim CW, Lee CR. Multifocal neuropathic arthropathy in patient with undiagnosed neurosyphilis: a case report. Int J STD AIDS. 2017;28(7):729–31.CrossRefGoogle Scholar
  64. 64.
    Park YH, Taylor JA, Szollar SM, Resnick D. Imaging findings in spinal neuroarthropathy. Spine. 1994;19(13):1499–504.CrossRefGoogle Scholar
  65. 65.
    Jacobelli S, McCarty DJ, Donald CS, Mall JC. Calcium pyrophosphate dihydrate crystal deposition in neuropathic joints: four cases of polyarticular involvement. Ann Intern Med. 1973;79(3):340–7.CrossRefGoogle Scholar
  66. 66.
    Durston JH, Jefferiss FJ. Syphilitic myositis. Br J Vener Dis. 1975;51:141–2.PubMedPubMedCentralGoogle Scholar
  67. 67.
    Mackay RP, Hall GW. Syphilitic amyotrophy. Arch NeurPsych. 1933;29(2):241–54.CrossRefGoogle Scholar
  68. 68.
    Wilson SAK. The pathology of two cases of tabetic amyotrophy. Rev Neurol Psychiat. 1911;9:401.Google Scholar
  69. 69.
  70. 70.
    Clement ME, Okeke NL, Hicks CB. Treatment of syphilis. A systematic review. JAMA. 2014;312(18):1905–17.CrossRefGoogle Scholar
  71. 71.
    Psomas KC, Brun M, Causse A, Atoui N, Reynes J, Le Moing V. Efficacy of ceftriaxone and doxycycline in the treatment of early syphilis. Med Mal Infect. 2012;42(1):15–9.CrossRefGoogle Scholar
  72. 72.
    Centers for Disease Control. 2015 sexually transmitted diseases treatment guidelines. Available at: http://www.cdc.gov/std/tg2015/syphilis.htm.
  73. 73.
    Gualtieri G, Sudanese A, Toni A, Giunti A. Loosening of a hip prosthesis in a patient affected with tabetic disease. Chir Organi Mov. 1991;76(1):83–5.PubMedGoogle Scholar
  74. 74.
    Yoshino S, Fujimori J, Kajino A, Kiowa M, Uchida S. Total knee arthroplasty in Charcot’s joint. J Arthroplast. 1993;8(3):335–40.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Najia Hajjaj-Hassouni
    • 1
  • Hanan Rkain
    • 2
  1. 1.Department of RheumatologyMohammed VI University of Health Sciences (UM6SS)CasablancaMorocco
  2. 2.Faculty of Medicine and Pharmacy, Departments of Rheumatology and PhysiologyMohammed V UniversityRabatMorocco

Personalised recommendations