Synovitis in secondary syphilis. Clinical, light, and electron microscopic studies

Area of Science:

• Rheumatology
• Infectious Diseases
• Pathology

Background:

• Secondary syphilis is a systemic infection with diverse clinical manifestations.
• Arthritis and tenosynovitis are uncommon but recognized presentations of secondary syphilis.

Purpose of the Study:

• To investigate the synovial pathology in patients presenting with joint symptoms suggestive of secondary syphilis.
• To identify the causative agent, Treponema pallidum, within the affected synovial tissue.

Main Methods:

• Clinical case review of patients with secondary syphilis and joint complaints.
• Synovial needle biopsy and histopathological examination.
• Electron microscopy of synovial tissue.

Main Results:

• Seven patients presented with polyarthritis and tenosynovitis attributed to secondary syphilis.
• Synovial biopsy showed mild synovitis with inflammatory cell infiltration and vascular changes.
• Electron microscopy identified necrotic polymorphonuclear leukocytes, debris, fibrin, and structures suggestive of Treponema pallidum.

Conclusions:

• Secondary syphilis can manifest with significant joint inflammation, including polyarthritis and tenosynovitis.
• Synovial biopsy findings, particularly with electron microscopy, can support the diagnosis of syphilitic arthritis.
• Treponema pallidum may be present in the synovial tissue of affected joints.