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Rapid, progressive neuropathic arthropathy of the hip in a patient co-infected with human immunodeficiency virus, hepatitis C virus and tertiary syphilis: case report.

Drago L, De Vecchi E, Pasqualini M, Moneghini L, Bruno M - BMC Infect. Dis. (2011)

Bottom Line: 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.He disclosed that he was seropositive for HCV and HIV, as confirmed by serology.The patient partially recovered the ability to walk.

View Article: PubMed Central - HTML - PubMed

Affiliation: Laboratory of Clinical Chemistry and Microbiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy. lorenzo.drago@unimi.it

ABSTRACT

Background: 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.

Case presentation: 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.

Conclusions: 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.

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CT image of the coxofemural joint showing extensive bone resorption.
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Figure 1: CT image of the coxofemural joint showing extensive bone resorption.

Mentions: The white cell count was elevated (10.1 × 109 cells/L; 74% neutrophils and 15.4% lymphocytes), the erythrocyte sedimentation rate (ESR) was 102 mm/h and the C reactive protein (CRP) level was 68.0 mg/L. The thromboplastin time was 21 sec (international normalized ratio [INR] 3.0); the activated partial thromboplastin time was 1.68 sec. CT scans revealed a wide zone of bone destruction (Figure 1). Because of poor bone quality and high risk of infection, a Girdlestone's procedure (non-prosthetic arthroplasty) was performed with a view to delay definitive prosthesis until the patient's general condition had improved. Histologic examination revealed complete destruction of the bone structure, with extensive areas of bone resorption and very few residual necrotic bony trabecules (Figure 2). The intertrabecular spaces revealed coagulative necrosis with histiocytic infiltration. In the residual vital bone there was lymphoplasmacellular infiltration, with non-necrotizing granulomas and multinucleated giant cells. Special staining (PAS, Ziehl-Neelsen, and Warthin-Star) showed no evidence of microorganisms.


Rapid, progressive neuropathic arthropathy of the hip in a patient co-infected with human immunodeficiency virus, hepatitis C virus and tertiary syphilis: case report.

Drago L, De Vecchi E, Pasqualini M, Moneghini L, Bruno M - BMC Infect. Dis. (2011)

CT image of the coxofemural joint showing extensive bone resorption.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3119072&req=5

Figure 1: CT image of the coxofemural joint showing extensive bone resorption.
Mentions: The white cell count was elevated (10.1 × 109 cells/L; 74% neutrophils and 15.4% lymphocytes), the erythrocyte sedimentation rate (ESR) was 102 mm/h and the C reactive protein (CRP) level was 68.0 mg/L. The thromboplastin time was 21 sec (international normalized ratio [INR] 3.0); the activated partial thromboplastin time was 1.68 sec. CT scans revealed a wide zone of bone destruction (Figure 1). Because of poor bone quality and high risk of infection, a Girdlestone's procedure (non-prosthetic arthroplasty) was performed with a view to delay definitive prosthesis until the patient's general condition had improved. Histologic examination revealed complete destruction of the bone structure, with extensive areas of bone resorption and very few residual necrotic bony trabecules (Figure 2). The intertrabecular spaces revealed coagulative necrosis with histiocytic infiltration. In the residual vital bone there was lymphoplasmacellular infiltration, with non-necrotizing granulomas and multinucleated giant cells. Special staining (PAS, Ziehl-Neelsen, and Warthin-Star) showed no evidence of microorganisms.

Bottom Line: 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.He disclosed that he was seropositive for HCV and HIV, as confirmed by serology.The patient partially recovered the ability to walk.

View Article: PubMed Central - HTML - PubMed

Affiliation: Laboratory of Clinical Chemistry and Microbiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy. lorenzo.drago@unimi.it

ABSTRACT

Background: 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.

Case presentation: 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.

Conclusions: 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.

Show MeSH
Related in: MedlinePlus