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Osteolytic lesions as the sole presenting feature of secondary syphilis
  1. Matthew Colquhoun1,
  2. Othman Kirresh2,
  3. Mohammad Keikha3 and
  4. Lewis Haddow4
  1. 1Rheumatology, Northwick Park Hospital, Harrow, UK
  2. 2Rheumatology, West Middlesex University Hospital, Isleworth, London, UK
  3. 3Radiology, West Middlesex Hospital, London, UK
  4. 4HIV and Genitourinary Medicine, Kingston Hospital NHS Foundation Trust, Kingston upon Thames, London, UK
  1. Correspondence to Dr Matthew Colquhoun; matthew.colquhoun{at}


We present the case of a 48-year-old man with a background of well-controlled HIV who presented with bony pain in multiple regions and raised inflammatory markers. After an investigative process, the patient was newly diagnosed with secondary syphilis. Bony pain, secondary to osteolytic lesions and demonstrated on plain radiography, CT and nuclear medicine imaging, was the sole presenting feature. The patient was successfully treated with penicillin G and his symptoms improved. Rheumatologists are often tasked with diagnosing the cause of a patient’s pain. However, in this case, a multidisciplinary approach was needed and the contribution of a specialist in Genitourinary Medicine/HIV was required to help diagnose this rare cause of bony pain.

  • bone and joint infections
  • public health
  • musculoskeletal syndromes

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  • Contributors MC was involved in the care of the patient and wrote and designed the manuscript. MK reviewed and edited the manuscript and provided consultant radiologist review of images. OK was the consultant rheumatologist involved in the care of the patient and reviewed the manuscript. LH was the HIV physician involved in the care of the patient and reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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