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Journal of Korean Neurosurgical Society > Volume 48(1); 2010 > Article
Journal of Korean Neurosurgical Society 2010;48(1): 85-87.
doi: https://doi.org/10.3340/jkns.2010.48.1.85
A Solitary Skull Lesion of Syphilitic Osteomyelitis.
Suk Hyung Kang, Seung Won Park, Ki Young Kwon, Won Jin Hong
1Department of Neurological Surgery, Yongsan Hospital, Chung-Ang University College of Medicine, Seoul, Korea. nspsw@cau.ac.kr
2Department of Pathology, Chung-Ang University College of Medicine, Seoul, Korea.
3Department of Neurological Surgery, Chu Hospital, Uijeongbu, Korea.
ABSTRACT
We experienced a rare case of solitary syphilitic osteomyelitis of the skull without any other clinical signs or symptoms of syphilis. A 20-year-old man was referred due to intermittent headache and mild tenderness at the right parietal area of the skull with a palpable coin-sized lesion of softened cortical bone. On radiological studies, the lesion was a radiolucent well enhanced mass (17 mm in diameter). The erythrocyte sedimentation rate (52 mm/h) and C-reactive protein (2.24 mg/dL) were elevated on admission. Serum venereal disease research laboratory (VDRL) and Treponema pallidum haemagglutination assay (TPHA) tests were positive. There were no clinical signs or symptoms of syphilis. After treatment with benzathine penicillin, we removed the lesion and performed cranioplasty. The pathologic finding of the skull lesion was fibrous proliferation with lymphoplasmocytic infiltration forming an osteolytic lesion. In addition, a spirochete was identified using the Warthin-starry stain. The polymerase chain reaction study showed a positive band for Treponema pallidum. Solitary osteomyelitis of the skull can be the initial presenting pathological lesion of syphilis.
Key Words: Infectious osteomyelitis; Syphilis; Skull; Treponema pallidum
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