Role of bone scintigraphy in the detection of periostitis in secondary syphilis

The authors report a case of a 35-year-old woman with secondary syphilis (rapid plasma reagin being positive at 1:64 dilution) and dermatologic manifestations of lues maligna (thick, crusted cutaneous plaques with erythematous borders showing mixed perivascular inflammatory infiltrates and areas of ulcerations) on punch biopsy. She presented with complaints of multiple skin sores, mild headache, and bilateral, nocturnal leg pain for 2 weeks, which was relieved by change in position of the extremities. The bone scan demonstrated multifocal bony involvement, without detectable radiographic abnormalities. Bone scintigraphy appears highly sensitive for the detection of skeletal lesions of secondary syphilis, which are radiographically undetectable and clinically asymptomatic. Bone scintigraphy should be an integral component of the initial work-up. The presence of bony lesions has significant clinical implications by potentially altering clinical management.