Forgotten but Not Gone! Syphilis Induced Tenosynovitis

Area of Science:

• Infectious Diseases
• Rheumatology
• Dermatology

Background:

• A 52-year-old male with a history of untreated syphilis presented with right fourth metacarpophalangeal joint swelling and pain.
• He had a prior history of painless penile lesions and a positive, high-titer RPR test, but was lost to follow-up.
• Examination revealed an edematous, nonerythematous right fourth proximal interphalangeal joint.

Purpose of the Study:

• To report a rare case of secondary syphilis presenting as tenosynovitis.
• To highlight the importance of considering syphilis in the differential diagnosis of tenosynovitis.
• To emphasize the reversibility of syphilis-related tenosynovitis with early diagnosis.

Main Methods:

• Surgical irrigation, debridement, and exploration of the affected tendon sheath were performed.
• Serological tests, including RPR (Rapid Plasma Reagin) and FTA-ABS (Fluorescent Treponemal Antibody Absorption) tests, were conducted.
• Clinical presentation and diagnostic workup were correlated to establish the diagnosis.

Main Results:

• The patient's RPR test was reactive with a high titer (1:64), and the FTA-ABS test was positive.
• Surgical intervention was performed on the affected finger.
• The diagnosis of secondary syphilis manifesting as tenosynovitis was confirmed based on clinical and laboratory findings.

Conclusions:

• Tenosynovitis is a rare but reversible manifestation of secondary syphilis.
• Early recognition and appropriate treatment are essential for managing syphilis-induced tenosynovitis.
• This case underscores the need for a comprehensive evaluation, including syphilis screening, in patients presenting with tenosynovitis.