A rare case of tertiary syphilis spondylodiscitis of the upper cervical spine: Diagnostic and therapeutic complexity, review of literature

  • Valerio Cipolloni Spine Division, Department of Orthopaedics and Traumatology, A. Gemelli University Hospital, Catholic University of Rome, Italy.
  • Luigi Aurelio Nasto Department of Pediatric Orthopaedics, IRCCS Istituto “G. Gaslini” Children’s Hospital, Genova, Italy.
  • Luca Piccone Spine Division, Department of Orthopaedics and Traumatology, A. Gemelli University Hospital, Catholic University of Rome, Italy.
  • Domenico Alessandro Santagada Spine Division, Department of Orthopaedics and Traumatology, A. Gemelli University Hospital, Catholic University of Rome, Italy.
  • Virginia Sangiorgi Spine Division, Department of Orthopaedics and Traumatology, A. Gemelli University Hospital, Catholic University of Rome, Italy.
  • Roberto Pola Department of Internal Medicine, Vascular Diseases, A. Gemelli University Hospital, Catholic University of Rome, Italy.
  • Antonello Leone Department of Radiology and Diagnostic Imaging, A. Gemelli University Hospital, Catholic University of Rome, Italy.
  • Enrico Pola | enrico.pola@tiscali.it Spine Division, Department of Orthopaedics and Traumatology, A. Gemelli University Hospital, Catholic University of Rome, Italy.

Abstract

Syphilis is a sexually transmitted disease caused by the spirochetes Treponema pallidum. Syphilitic spinal lesions present as erosive bone lesions often simulating spondylodiscitis or cancer. In this article we describe a rare case of cervical osteolytic lesion from tertiary syphilis. A 45-year-old male with axial neck pain, without fever presented with an isolated osteolytic lesion at C3. Tuberculous spondylitis was initially suspected. A new CT and contrast enhanced MRI of the cervical spine and of the neck showed an extention of the bone lesion at C3 with bilateral lymphadenomegaly. To confirm the diagnosis of tertiary syphilis, US-guided biopsy of the lymph nodes was performed. The patient was treated with i.m. benzylpenicillin 2.4 MIU and the follow-up showed clinical and radiological resolution of the condition. The aim of this case report is to raise awareness of tertiary syphilis in the differential diagnosis of lytic lesions of the spine among the spinal community.

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Published
2020-06-25
Keywords:
Tertiary syphilis, Treponema pallidum, Osteolytic spinal lesion, VDRL test, Benzylpenicillin.
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How to Cite
Cipolloni, V., Nasto, L. A., Piccone, L., Santagada, D. A., Sangiorgi, V., Pola, R., Leone, A., & Pola, E. (2020). A rare case of tertiary syphilis spondylodiscitis of the upper cervical spine: Diagnostic and therapeutic complexity, review of literature. Orthopedic Reviews, 12(1s). https://doi.org/10.4081/or.2020.8675

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