Page 52 - ARNM-2-1

Advances in Radiotherapy &

Nuclear Medicine

CASE REPORT
Secondary syphilis: An unusual cause of

osteolytic lesion diagnosed by 99m Tc-MDP SPECT
and presenting features

1
1
Xia Lu *, Chifeng Xu , Haizhong Zhou , Qin Xiao , and Huiying He *
3
2
1
1 Department of Nuclear Medicine, Northern Jiangsu People’s Hospital, Yangzhou, China
2 Department of Pathology, Northern Jiangsu People’s Hospital, Yangzhou, China
3 Department of Pathology, School of Basic Medical Sciences, Peking University Third Hospital,
Peking University Health Science Center, Beijing, China

Abstract
Herein, we present the case of a 68-year-old woman complaining of pain of the right
knee, which was initially misdiagnosed by plain radiography as fracture on inner
right tibia plateau but was finally clarified as osteolytic lesion secondary to syphilis
affecting the whole right knee. The final diagnosis was made based on the valuable
findings from bone scanning, which allows for imaging of abnormalities with much
larger extent, a scale that is out of the examination capacity of plain radiography.
Bone scanning was employed in this case, coupled with the use of 99m Tc-MDP, to
assess abnormal bone metabolism at the whole right knee next to the tibia plateau.
*Corresponding authors: The imaging results illustrated the diverse features of bone involvement of secondary
Xia Lu
(lxgf2222@163.com) syphilis, including periostitis, osteolysis as well as osteomyelitis, occurring together
Huiying He or in isolation.
(huiyinghe@bjmu.edu.cn))
Citation: Lu X, Xu C, Zhou H, 99m
Xiao Q, He H. Secondary syphilis: Keywords: Secondary syphilis; Osteomyelitis; Tc-MDP SPECT; Right knee
An unusual cause of osteolytic
lesion diagnosed by 99m Tc-MDP
SPECT and presenting features.
Adv Radiother Nucl Med.
2024;2(1):2204. 1. Background
https://doi.org/10.36922/arnm.2204
Syphilis remains a major public health concern worldwide. It has been estimated that the
Received: November 8, 2023 global incidence of syphilis stands as 10.6 million/year and has been showing increasing
Accepted: January 26, 2024 trend over past two decades in China, making it the most common sexually transmitted
disease in the country. Unfortunately, the epidemiologic studies on syphilis conducted
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Published Online: March 26, 2024
thus far have largely neglected an in-depth analysis on the transmission of syphilis from
Copyright: © 2024 Author(s). husbands who have multiple sex partners to their wives, an area in this subject that
This is an Open-Access article deserves more attention. 4
distributed under the terms of the
Creative Commons Attribution Bone and joint involvement in secondary syphilis rarely occurs but is more
License, permitting distribution,
and reproduction in any medium, commonly seen in congenital and tertiary syphilis. In a retrospective study of
provided the original work is 854 patients diagnosed with secondary syphilis, only 2 (0.2%) patients were found to
properly cited. have bone lesions. Early diagnosis and effective treatment are crucial for improving
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6
Publisher’s Note: AccScience the outcomes of syphilis and preventing further spread of the disease. Improvement
Publishing remains neutral with of a wide array of imaging modalities, along with a deepening understanding of the
regard to jurisdictional claims in
published maps and institutional imaging features of osseous syphilis, could lead to easier diagnosis of the disease.
affiliations. However, there has been a lack of reports on functional nuclear medicine imaging

Volume 2 Issue 1 (2024) 1 https://doi.org/10.36922/arnm.2204