Acute periostitis affecting the long bones is a charac teristic but uncommon manifestation of syphilis in the adult with an early acquired infection. This report de scribes the history of a jogger who developed acute localized periostitis of the shaft of both tibiae during the early stage of acquired syphilis. Symptomatology was initially attributed to the medial tibial stress syndrome.

Acute periostitis in early acquired syphilis simulating shin splints in a jogger

We report the case of a 64-year-old man who initially presented with a maculopapular rash followed several weeks later by bilateral shin pain and infiltrative cutaneous lesions over the lower legs. The plain radiographs were not contributory, and the patient was referred for a whole-body bone scan, which demonstrated multifocal osseous lesions, including such lesions in the lower legs, skull and facial bones. Magnetic resonance imaging (MRI) demonstrated numerous small tibial and fibular nodular lesions involving the medullary cavity and the cortex. A diagnosis of acquired syphilis was made, based on skin biopsy. Results of serological testing were consistent with recent infection. The patient was treated with intramuscular injection of penicillin, and follow-up MRI demonstrated gradual resolution of the osseous lesions. Bone involvement is a relatively rare manifestation of early acquired syphilis. Although the plain radiographic features of the bony changes in acquired syphilis are well documented, there have been no reports of the magnetic resonance imaging findings in the appendicular skeleton.

Magnetic resonance imaging features of osseous manifestations of early acquired syphilis.

Cerebral syphilitic gumma presenting with intracranial gumma and pathologic vertebrae fractures.

Calvarial osteomyelitis in secondary syphilis: evaluation by MRI and CT, including cinematic rendering.

Syphilitic osteomyelitis of the mandible

The statement that syphilis is a great “imitator” finds no exception in its bone lesions. Roentgenograms of bones with syphilitic involvement are by no means always characteristic, as they may simulate chronic non-specific osteomyelitis, primary bone tumor, metastatic cancer, multiple myeloma, or any other type of bone lesion. The abundant blood supply to the bone marrow and periosteum tends to make these structures a good reservoir of infection. The causative organism is borne through the blood stream to all parts of the body. The disease is thus propagated via the blood stream, and the invasion of the periosteum or bone is to be expected. If we accept the hypothesis, which appears to be true, that the entire process, as far as bone involvement is concerned, represents an osteomyelitis, it is possible to understand the varying roentgen manifestations. The end-results may be necrosis, sclerosis, osteoporosis, sequestrum formation, or spontaneous fracture. Any combination of these findings may be present s...

C. P. Truog

Papers

Bone Lesions in Acquired Syphilis1