Simultaneous ocular and osseous syphilis: a case report

ABSTRACT Syphilis is a reemerging and potentially serious disease. Owing to its ubiquity and pleomorphism, it is called “the great imitator”. We report the case of a young woman with secondary syphilis who presented with bilateral acute syphilitic posterior placoid chorioretinopathy along with a syphilitic skull periostitis. A pachymeningeal enhancement was observed on magnetic resonance imaging, but we believe it was an extension of the bone process rather than a meningitis itself on the basis of the normal cerebrospinal fluid analysis results. Treatment with intravenous crystalline penicillin resulted in complete resolution of the signs, symptoms, and imaging findings. Secondary syphilis is the stage with the highest bacteremia and the highest transmissibility, presenting mainly with mucocutaneous disorders and, less frequently, with involvement of other organs. High suspicion and a pragmatic approach are essential to the diagnosis because this disease can affect several organs, as in the present case, in which the eyes, bones, and skin were affected.

摘要
梅毒是一种复发性且具有潜在严重危害性的疾病。因其分布广泛、表现多样，被称为“伟大的模仿者”。本文报告1例二期梅毒年轻女性患者，其同时合并双侧急性梅毒性后部斑块状脉络膜视网膜炎（acute syphilitic posterior placoid chorioretinopathy）与梅毒性颅骨骨膜炎。磁共振成像（Magnetic Resonance Imaging）检查可见硬脑膜肥厚强化，但结合脑脊液分析结果正常，我们认为该表现为骨病变的延伸，而非脑膜炎本身。予以结晶青霉素静脉输注治疗后，患者的体征、症状及影像学表现均完全消退。二期梅毒是菌血症水平与传播性最高的阶段，主要以黏膜皮肤病变为表现，较少累及其他器官。由于梅毒可累及多个器官（如本例患者同时累及眼、骨与皮肤），因此高度的临床怀疑态度与务实的诊疗策略对确诊至关重要。