Osseous and meningeal involvement in secondary syphilis

Osseous involvement, although typically described in congenital or tertiary syphilis, has rarely been reported in secondary syphilis. Spirochetes are transported to the medullary cavity or within the deep periosteal vasculature via hematological spread and may be seen in biopsies of the osseous lesions. The skull, shoulder girdle, and long bones are most commonly affected. Patients present with bone pain, which may manifest as headaches or shin splits, depending on the affected bone. This case illustrates the importance of including secondary syphilis in the differential diagnosis of a cutaneous eruption accompanied with headaches. Although the CT scan and CSF testing were negative, the MRI showed osseous and meningeal involvement.