Musculoskeletal involvement of syphilis--a forgotten lesson

Area of Science:

• Infectious Diseases
• Dermatology
• Rheumatology

Background:

• Syphilis is a complex sexually transmitted infection known for its diverse clinical manifestations, often leading to misdiagnosis.
• Despite effective treatments like penicillin, syphilis remains a global health concern, with potential for late-stage complications if untreated.
• The 'great impostor' moniker stems from syphilis's ability to mimic numerous other diseases, posing diagnostic challenges.

Observation:

• A case is presented where a patient experienced a significant delay between primary syphilis infection and hospital admission due to a fever of unknown origin.
• The patient presented with joint deformities, a less common manifestation of late-stage syphilis.
• A prior diagnosis of psoriasis led to the neglect of secondary syphilis skin lesions, contributing to the diagnostic delay.

Findings:

• The case illustrates a rare, decades-long latency period of syphilis.
• The patient's symptoms were initially misattributed to psoriasis, masking the underlying syphilitic infection.
• Untreated primary syphilis progressed to late-stage manifestations, including fever and joint deformities.

Implications:

• This case underscores the importance of considering syphilis in differential diagnoses, even with atypical or long-delayed presentations.
• Improved awareness among clinicians regarding the varied and sometimes subtle signs of syphilis is crucial for timely diagnosis and treatment.
• Highlighting the potential for misdiagnosis emphasizes the need for comprehensive patient histories and diagnostic workups in complex cases.