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Abstract：
BACKGROUND: Treponema Pallidum (TP), the pathogen of syphilis, commonly infects bones in cases of congenital and tertiary syphilis, but it is rare in the primary and secondary stages. With its mild symptoms and rare clinical findings, it might be easy to dismiss the diagnosis of early syphilis. Usually, effective results can be achieved after the conventional strategy of antibiotic treatments, mainly penicillin. To our knowledge, our case is so far the most serious reported case of destructive bone lesion in secondary syphilis, and our treatment for the case is the first strategy using total hip arthroplasty in secondary syphilis.
METHODS: We present the case of a 71-year-old man with local repeated pain and dysfunction in the right hip. Radiologic examinations showed the disappearance of the ipsilateral femoral head and neck. After excluding the aetiologies of cancer metastasis and tuberculosis, we confirmed the diagnosis of syphilitic arthritis. The patient received the medical treatment of antibiotics and the surgical treatment of total hip arthroplasty. At the follow-up of 1, 3, and 5.5 years after the operation, the patient presented with a pain-free and functional hip prosthesis without local signs of infection and loosening.
CONCLUSIONS: This report highlights the difficulties of early diagnosis of secondary syphilis with bone involvement. Bone defect of the femur with secondary syphilis, especially at the proximal femur, was an extremely rare complication in the previous reports. Our case was the first case of a patient who experienced the disappearance of femoral head and neck caused by secondary syphilis. Follow-up after the operation proved the successful treatment of the extensive bone defect of femur by total hip arthroplasty.
METHODS: We present the case of a 71-year-old man with local repeated pain and dysfunction in the right hip. Radiologic examinations showed the disappearance of the ipsilateral femoral head and neck. After excluding the aetiologies of cancer metastasis and tuberculosis, we confirmed the diagnosis of syphilitic arthritis. The patient received the medical treatment of antibiotics and the surgical treatment of total hip arthroplasty. At the follow-up of 1, 3, and 5.5 years after the operation, the patient presented with a pain-free and functional hip prosthesis without local signs of infection and loosening.
CONCLUSIONS: This report highlights the difficulties of early diagnosis of secondary syphilis with bone involvement. Bone defect of the femur with secondary syphilis, especially at the proximal femur, was an extremely rare complication in the previous reports. Our case was the first case of a patient who experienced the disappearance of femoral head and neck caused by secondary syphilis. Follow-up after the operation proved the successful treatment of the extensive bone defect of femur by total hip arthroplasty.
摘要：
背景：梅毒螺旋体（TP），梅毒的病原体,在先天性和三级梅毒病例中通常会感染骨骼，但在初级和次级阶段很少见。症状轻微，临床表现罕见，早期梅毒的诊断可能很容易被驳回。通常,经过常规的抗生素治疗策略，可以取得有效的效果，主要是青霉素。据我们所知,我们的病例是迄今为止报道的最严重的继发性梅毒破坏性骨病变病例，我们对这种情况的治疗是在二期梅毒中使用全髋关节置换术的第一种策略。
方法：我们介绍了一名71岁男性患者的右髋关节局部反复疼痛和功能障碍。放射学检查显示同侧股骨头和颈部消失。在排除癌症转移和结核病的病因后，我们证实了梅毒性关节炎的诊断。患者接受了抗生素的药物治疗和全髋关节置换术的手术治疗。在术后1年、3年和5.5年的随访中，患者出现无痛和功能性的髋关节假体，没有局部感染和松动的迹象。
结论：本报告强调了二期梅毒骨受累的早期诊断困难。股骨骨缺损伴二期梅毒,尤其是在股骨近端,是以前报道中极为罕见的并发症。我们的病例是首例经历了继发性梅毒引起的股骨头和颈部消失的患者。术后随访证明全髋关节置换术成功治疗股骨广泛骨缺损。
方法：我们介绍了一名71岁男性患者的右髋关节局部反复疼痛和功能障碍。放射学检查显示同侧股骨头和颈部消失。在排除癌症转移和结核病的病因后，我们证实了梅毒性关节炎的诊断。患者接受了抗生素的药物治疗和全髋关节置换术的手术治疗。在术后1年、3年和5.5年的随访中，患者出现无痛和功能性的髋关节假体，没有局部感染和松动的迹象。
结论：本报告强调了二期梅毒骨受累的早期诊断困难。股骨骨缺损伴二期梅毒,尤其是在股骨近端,是以前报道中极为罕见的并发症。我们的病例是首例经历了继发性梅毒引起的股骨头和颈部消失的患者。术后随访证明全髋关节置换术成功治疗股骨广泛骨缺损。
