Osteolytic lesions in secondary syphilis

Area of Science:

• Infectious Diseases
• Pathology
• Rheumatology

Background:

• Secondary syphilis is a systemic infection caused by Treponema pallidum.
• Bone involvement in secondary syphilis is uncommon, with osteolytic lesions being particularly rare.
• Diagnosis often relies on serological tests and clinical presentation.

Observation:

• A 37-year-old male presented with bone pain, night sweats, and skin lesions indicative of secondary syphilis.
• Radiographs revealed osteolytic lesions in the long bones (tibiae, fibulae, radii, ulnae).
• A tibial biopsy showed bone necrosis, inflammation, and abundant spirochetes.

Findings:

• Histopathological examination of the tibial biopsy unequivocally demonstrated the presence of numerous spirochetes within the necrotic bone tissue.
• The patient's symptoms and radiographic findings resolved completely following penicillin treatment.
• This case provides strong histopathological evidence linking osteolytic bone lesions directly to Treponema pallidum infection.

Implications:

• This case highlights the importance of considering secondary syphilis in the differential diagnosis of osteolytic bone lesions, even when rare.
• The histopathological confirmation of spirochetes in bone necrosis underscores the potential for extensive syphilitic involvement.
• Effective treatment with penicillin confirmed the etiology and led to complete resolution of symptoms.