Learning objectives
Learning Objectives: Present a case series of secondary syphilis with a review of the classical radiological presentations.
Background
Background:Syphilis is a systemic chronic illness that can present at various stages and can have unique radiological findings [1]. In Australia, the incidence of syphilis is on the increase, with notifications increasing 135% between 2013 to 2017 [2]. The natural history of untreated syphilis has classically been described in four stages: primary, secondary, latent and tertiary syphilis [3,4]. Syphilis is known as the ‘great imitator’, as patients can present with constitutional symptoms or symptoms due to organ-specific involvement [5]. Neurosyphilis manifestations may occur both in...
Imaging findings OR Procedure details
Imaging Findings:
Case 1 presented with a one month history of bilateral hearing loss, unsteadiness of gait and increasing headaches. The patient was otherwise immunocompetent patient but with high risk sexual history.
Case 2 presented with increasing headaches, tender palpable scalp lesions and positive syphilis serology in an immunocompetent patient with no risk factors.
Case 3 presented with a history of prior syphilis infection, increasing falls and gait disturbance. The patient did not report any significant pain and had completed a prior course of therapy....
Conclusion
Conclusion: This case series illustrates the imaging findings of three rare neuroradiological presentations of syphilis - oto-labyrinthine syphilis, gummatous calvarial syphilitic osteomyelitis, and a case of chronic tabesdorsalis with lumbar neuroarthropathic “Charcot” spine. These noteworthy examples of secondary syphilis presentations in otherwise immunocompetent patients highlight the increasing incidence of syphilis in the community in Australia which warrants an awareness of how this ‘great imitator’ can present on imaging.
Keywords: Syphilis, neurosyphilis, imaging, MRI, stages, oto-syphilis, calvarial, osteomyelitis, tabesdorsalis.
Personal information
B. Hudson:
Nothing to disclose
J. Drummond:
Nothing to disclose
References
References:
1. Smith, AB, Smirniotopoulos, JG, Rushing, EJ. Central Nervous System Infections Associated with Human Immunodeficiency Virus Infection: Radiologic-Pathologic Correlation. RadioGraphics. 2008 November-December, Volume 2(7): 2033-2059.
2. Department of Health [homepage on the internet]. Canberra: Australian Government; 2019 June 09; cited 2021 March 17. 36 Syphilis. Available from: https://www.health.gov.au/resources/pregnancy-care-guidelines/part-f-routine-maternal-health-tests/syphilis
3. Hook, EW. Syphilis. The Lancet Seminar. 2017 April Volume 389 [10078]: 1550-1557.
4. Petroulia V, Surial B, Verma RK, Hauser C, Hakim A. Calvarial osteomyelitis in secondary syphilis: evaluation by MRI and CT, including cinematic...