[Multi-Faceted Symptoms with Joint Pain, Exanthema and Eye Involvement]

In this case series, we describe 4 patients who presented to a rheumatologic clinic with very different complains however were ultimately diagnosed with the same underlying disease. The wide spectrum of symptoms included generalized maculopapular exanthema, arthralgia, myalgia and vision problems. One patient received anti-TNF therapy for ankylosing spondylitis and recurrent uveitis. On exam, joint swelling and skin changes were found.

All patients were found to have an elevated Treponema pallidum antibody titer and a positive of the rapid plasma reagin test.

Patients were diagnosed with syphilis.

The first three patients received an intramuscular injection of 2.4 million benzabine penicillin G. The fourth patient was treated with penicillin 6 million IV 4 times a day for more than 14 days, due to immunosuppression CONCLUSION:  In the presence of non-specific and often rather diffuse symptoms, with which patients in rheumatology often present, a non-primary rheumatological, e. g. infectious genesis, also needs to be considered. Due to the increasing incidence of syphilis in Germany in recent years special attention needs to be paid to this disease in rheumatological care.