Rapid, progressive neuropathic arthropathy of the hip in a patient co-infected with human immunodeficiency virus, hepatitis C virus and tertiary syphilis: case report
Articolo
Data di Pubblicazione:
2011
Citazione:
Rapid, progressive neuropathic arthropathy of the hip in a patient co-infected
with human immunodeficiency virus, hepatitis C virus and tertiary syphilis: case
report / L. Drago, E. De Vecchi, M. Pasqualini, L. Moneghini, M. Bruno. - In: BMC INFECTIOUS DISEASES. - ISSN 1471-2334. - 11(2011 Jun 06), pp. 159.159-1-159.159-4.
Abstract:
BACKGROUND: Syphilis is a chronic infection that is classified into
three stages. In its tertiary stage, syphilis spreads to the brain, heart and
other organs; the lesions may involve the skin, mucous membranes and bones.
Neuropathic arthropathy associated with tertiary syphilis has rarely been
described in Europe and its association with HIV-HCV co-infection has not been
reported so far.This article reports the case of a man with tertiary syphilis
presenting with rapidly evolving neuropathic arthropathy of the hip and extensive
bone destruction.
CASE PRESENTATION: On initial presentation, the patient complained of
progressively worsening left-sided coxalgia without localized or generalized
inflammation. The patient reported to have no history of previous infections,
trauma or cancer. Plain x-ray films of the left coxofemoral joint showed marked
degeneration with necrosis of the proximal epiphysis of femur and morphological
alterations of the acetabulum without protrusion. Primary coxarthrosis was
diagnosed and hip arthroplasty was offered, but the patient declined treatment.
Three months later, the patient presented a marked deterioration of his general
condition. He disclosed that he was seropositive for HCV and HIV, as confirmed by
serology. Syphilis serology testing was also positive. A Girdlestone's procedure
was performed and samples were collected for routine cultures for bacteria and
acid fast bacilli, all resulting negative.Although histological findings were
inconclusive, confirmed positive serology for syphilis associated with
progressive arthropathy was strongly suggestive of tertiary syphilis, probably
exacerbated by HIV-HCV co-infection. The patient partially recovered the ability
to walk.
CONCLUSIONS: Due to the resurgence of syphilis, this disease should be considered
as a possible cause of neuropathic arthropathy when other infectious causes have
been ruled out, particularly in patients with HIV and/or HCV co-infection.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Charcot arthropathy; HIVHCV; Neuropathy Syphilis
Elenco autori:
L. Drago, E. De Vecchi, M. Pasqualini, L. Moneghini, M. Bruno
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