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Advances in Radiotherapy
& Nuclear Medicine Bone scan image features of secondary syphilis

This case highlights the importance of bone scanning Author contributions
in the diagnosis of secondary syphilis and presents a
case of single predominant damage of the right knee Conceptualization: Xia Lu
joint, which is distinct from other reported cases. It has Formal analysis: Haizhong Zhou
been reported that only 24% of the cases of secondary Investigation: Qin Xiao
Methodology: Chifeng Xu
syphilis with bone involvement showed high-titer results Writing – original draft: Xia Lu
in nontreponemal serologic tests. Many of these cases Writing – review & editing: Huiying He
7
demonstrated multifocal bone involvement but reports on
secondary syphilis affecting the sternum, skull, and fibula Ethics approval and consent to participate
remain scarce. 7-10 Bony lesions due to secondary syphilis
are pathologically complex and may exhibit in the form of Verbal consent was obtained from the patient before
periostitis, osteolysis, and osteomyelitis, which may occur participation.
together or in isolation. It is widely recognized that the Consent for publication
accumulation of technetium-labeled radiopharmaceuticals
in bony lesions is a primary indication of increased osteoid The patient gave consent verbally for releasing their data
formation, increased blood flow, increased mineralization in this paper.
of osteoid, and interrupted sympathetic nerve supply.
11
However, none of above mechanisms seem to explain the Availability of data
increased radionuclide activity in bony lesion occurring Data are available from the corresponding author upon
on the right knee. Instead, infiltration of inflammatory reasonable request.
cells, such as lymphocyte and macrophage, resulting in the
increased uptake of bone-seeking radiopharmaceuticals Referencess
seems to offer a plausible explanation for the current case 1. Pham MD, Ong JJ, Anderson DA, Stoové M. Point-of-care
of bone lesions due to secondary syphilis. Nevertheless, diagnostics for diagnosis of active syphilis infection: Needs,
this postulated mechanism warrants validation in further challenges and the way forward. Int J Environ Res Public
experiments. Health. 2022;19(13):8172.
4. Conclusion doi: 10.3390/ijerph19138172
2. Wan Z, Zhang H, Xu H, et al. Maternal syphilis treatment
The current report showcases the insidious nature of and pregnancy outcomes: A retrospective study in
bone lesions secondary to syphilis, evidenced by the Jiangxi Province, China. BMC Pregnancy Childbirth.
manifestations of apparent symptoms years after acquiring 2020;20(1):648-654.
the sexually transmitted disease. The bone lesion may have a doi: 10.1186/s12884-020-03314-y
poor prognosis if an early diagnosis and effective treatment
is not possible. A crossover of multiple disciplines through 3. Tuddenham S, Ghanem KG. Emerging trends and persistent
physiologic studies and imaging should be considered challenges in the management of adult syphilis. BMC Infect
in diagnosing sexually transmitted infections with bone Dis. 2015;15:351-359.
lesions involvement. doi: 10.1186/s12879-015-1028-3.
4. Han L, Xiong WX, Li MZ, et al. Couple-level determinants
Acknowledgments of syphilis infection among heterosexual married couples
The authors would like to thank the participating patient, of reproductive age in Guangdong Province, China:
as well as the colleagues and nurses who made this work A population-based cross-sectional study. Front Public
possible. Health. 2022;10:1004246.
doi: 10.3389/fpubh.2022.1004246
Funding
5. Mindel A, Tovey SJ, Timmins DJ, Williams P. Primary and
This work was supported by the foundation of “Lvyang secondary syphilis, 20 years’ experience. 2. Clinical features.
Jinfeng” talents attracting plan (LYJF00040) and Genitourin Med. 1989;65(1):1-3.
Jiangsu Provincial Health Commission General Project doi: 10.1136/sti.65.1.1
(H2023055).
6. Chen JH, Zheng X, Liu XQ. Usefulness of positron emission
Conflict of interest tomography in patients with syphilis: A systematic
review of observational studies. Chin Med J (Engl).
The authors declare that they have no competing interests. 2017;130(9):1100-1112.

Volume 2 Issue 1 (2024) 3 https://doi.org/10.36922/arnm.2204