Laboratory of Clinical Chemistry and Microbiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy.
BMC Infect Dis. 2011 Jun 6;11:159. doi: 10.1186/1471-2334-11-159.
Syphilis is a chronic infection that is classified into three stages. In its tertiary stage, syphilis spreads to the brain, heart and other organs; the lesions may involve the skin, mucous membranes and bones. Neuropathic arthropathy associated with tertiary syphilis has rarely been described in Europe and its association with HIV-HCV co-infection has not been reported so far.This article reports the case of a man with tertiary syphilis presenting with rapidly evolving neuropathic arthropathy of the hip and extensive bone destruction.
On initial presentation, the patient complained of progressively worsening left-sided coxalgia without localized or generalized inflammation. The patient reported to have no history of previous infections, trauma or cancer. Plain x-ray films of the left coxofemoral joint showed marked degeneration with necrosis of the proximal epiphysis of femur and morphological alterations of the acetabulum without protrusion. Primary coxarthrosis was diagnosed and hip arthroplasty was offered, but the patient declined treatment. Three months later, the patient presented a marked deterioration of his general condition. He disclosed that he was seropositive for HCV and HIV, as confirmed by serology. Syphilis serology testing was also positive. A Girdlestone's procedure was performed and samples were collected for routine cultures for bacteria and acid fast bacilli, all resulting negative.Although histological findings were inconclusive, confirmed positive serology for syphilis associated with progressive arthropathy was strongly suggestive of tertiary syphilis, probably exacerbated by HIV-HCV co-infection. The patient partially recovered the ability to walk.
Due to the resurgence of syphilis, this disease should be considered as a possible cause of neuropathic arthropathy when other infectious causes have been ruled out, particularly in patients with HIV and/or HCV co-infection.
梅毒是一种慢性传染病，分为三期。三期梅毒会扩散至大脑、心脏和其他器官；病变可能涉及皮肤、黏膜和骨骼。欧洲鲜有报道三期梅毒相关的神经病理性关节病，也未有报道称其与 HIV-HCV 合并感染相关。本文报告了一例三期梅毒患者，表现为迅速进展的髋关节神经病理性关节病和广泛的骨破坏。
患者初次就诊时主诉左侧髋部进行性加重的疼痛，但无局部或全身炎症。患者自述无既往感染、创伤或癌症史。左侧髋关节正位 X 线片显示严重退变，股骨近端骨骺坏死，髋臼形态改变但无突出。诊断为原发性髋关节骨关节炎，并建议行髋关节置换术，但患者拒绝治疗。三个月后，患者一般状况明显恶化。他透露自己 HCV 和 HIV 血清学阳性，经血清学检查得到证实。梅毒血清学检查也呈阳性。随后行 Girdlestone 手术，并采集常规细菌和抗酸杆菌培养标本，均为阴性。虽然组织学检查结果不确定，但与进行性关节病相关的明确阳性梅毒血清学强烈提示为三期梅毒，可能因 HIV-HCV 合并感染而加重。患者部分恢复了行走能力。
由于梅毒的再次流行，在排除其他感染性病因后，尤其是在 HIV 和/或 HCV 合并感染的患者中，应考虑将其作为神经病理性关节病的可能病因。
