SYPHILITIC OSTEITIS IN A PATIENT WITH SECONDARY SYPHILIS AND CONCURRENT HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Destructive bone disease is a well-recognized complication of congenit al and tertiary syphilis. Clinically significant osteitis and osteomye litis are rare complications of primary or secondary syphilis in patie nts who are not infected with human immunodeficiency virus (HIV). We r eport a case of an HIV-infected man who presented with symptomatic, le ft ulnar osteitis as the initial manifestation of secondary syphilis. The patient's clinical course was complicated by a pathological fractu re, but he responded to high-dose intravenous penicillin G therapy and surgical intervention. Results of physical examination on follow-up a t 15 months were normal, and a serofast (rapid plasma reagin [RPR]) ti ter of 1:4 and a markedly decreased uptake on bone scintigraphy were o bserved. Our case report suggests that bone disease can represent an a typical manifestation of early acquired syphilis and that HIV-positive patients who present with orthopedic complaints or bone lesions shoul d be evaluated for the presence of syphilitic bone disease.