Ratnaraj Felicia, Brooks David, Walton Mollie, Nagabandi Arun, Abu Hazeem Mahmoud
CHI Health Creighton University Medical Center, Omaha, NE, USA.
Case Rep Infect Dis. 2016;2016:7420938. doi: 10.1155/2016/7420938. Epub 2016 Dec 6.
. Tenosynovitis, inflammation of a tendon and its synovial sheath, is a rare manifestation of secondary syphilis and if diagnosed early is reversible. . A 52-year-old male with past medical history of untreated syphilis presented with gradual onset of swelling and pain of the right fourth metacarpophalangeal joint (MCP). He reported a history of painless penile lesions after having sexual intercourse with a new partner approximately five months ago which was treated with sulfamethoxazole/trimethoprim. An RPR done at that time came back positive with a high titer; however, patient was lost to follow-up. On examination, patient had an edematous, nonerythematous right fourth proximal interphalangeal (PIP) joint. Urgent irrigation, debridement, and exploration of the right hand into the tendon sheath were performed. With his history of syphillis, an RPR was done, which was reactive with a titer of 1 : 64. A confirmatory FTA-ABS test was completed, rendering a positive result. Based on his history of untreated syphilis, dormancy followed by clinical scenario of swelling of the right fourth finger, and a high RPR titer, he was diagnosed with secondary syphilis manifesting as tenosynovitis.
腱鞘炎，即肌腱及其腱鞘的炎症，是二期梅毒的一种罕见表现，若早期诊断则可逆转。一名52岁男性，有未经治疗的梅毒病史，出现右手中指掌指关节（MCP）逐渐肿胀和疼痛。他报告大约五个月前与新伴侣发生性行为后出现无痛性阴茎病变，当时用磺胺甲恶唑/甲氧苄啶治疗。当时进行的快速血浆反应素环状卡片试验（RPR）结果呈高滴度阳性；然而，患者失访。检查时，患者右手第四近端指间关节（PIP）水肿，无红斑。对右手进行了紧急冲洗、清创，并探查至腱鞘。鉴于其梅毒病史，再次进行RPR检测，滴度为1:64，呈反应性。完成了确诊的荧光密螺旋体抗体吸收试验（FTA-ABS），结果呈阳性。基于他未经治疗的梅毒病史、潜伏期、随后右手第四指肿胀的临床情况以及高RPR滴度，他被诊断为表现为腱鞘炎的二期梅毒。
