Syphilis is a chronic venereal disease caused by Treponema pallidum (TP). Destructive arthritis is rare in its primary and secondary stages but can occur in the tertiary stage and its congenital form.
A 56-year-old male patient presented with a 2-week history of nontraumatic pain and swelling in the fifth distal interphalangeal (DIP) joint on his right hand. On physical examination, redness, swelling, and tenderness were noted, depicting inflammation. Additionally, a diffuse maculopapular rash on the trunk, palms, and soles stood out, accompanying a generalized lymphadenopathy. He reported history of a genital lesion following sexual intercourse with a new partner approximately 1 year ago. Plain radiograph (Figure 1A) revealed a complete destruction of the subchondral bone on both joint sides, joint effusion, and soft tissue edema. Inflammatory markers were increased, and both Venereal Disease Research Laboratory test and TP hemagglutination assay test were positive. Due to the suspicion of septic arthritis, a debridement and arthrodesis were performed. A histological analysis of the bone specimen revealed a pattern suggesting septic arthritis (Figure 1B). Immunohistochemical staining confirmed the presence of spirochetes and PCR test for TP DNA was positive. A diagnosis of secondary syphilis was made, and the patient was treated promptly.
(A) Fifth distal interphalangeal plain radiograph before (left) and after (right) syphilitic arthritis. (B) Histological aspect of the biopsy specimen. Trabecular bone tissue with reactive changes was observed. Fibrosis and mononuclear chronic inflammatory infiltrate was identified in the intertrabecular spaces (H&E stain, 200×).
Here we report the case of a secondary syphilis that presented with small joint destructive monoarthritis. Although uncommon in earlier stages of the infection, our case highlights the importance of keeping a high suspicion on syphilitic arthritis throughout the entire course of the disease.
Footnotes
The authors declare no conflicts of interest relevant to this article. Institutional review board approval was not required for this article according to the authors’ institutions. The patient provided informed written consent.
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