Abstract:

The first case of acquired syphilitic skull osteitis accompanied by syphilitic meningitis in China is reported. A 55-year-old female presented with a persistent distending pain of the frontal and occipital regions of the skull for two months. T1 weighted magnetic resonance imaging （MRI） showed multiple lesions in the skull and linear enhancement of the meninge near the lesions. The serum and cerebrospinal fluid （CSF） were positive for Treponema pallidum particle agglutination assay （TPPA） and rapid plasma reagin circle card test （at the dilutions of 1 ∶ 32 and 1 ∶ 4 respectively）. The levels of leukocyte and protein were 10 × 106/L and 0.82 g/L respectively in CSF. TP DNA was detected in the calvarial periosteum. Histopathological examination of the frontal bone showed focally destructive osteolytic lesions with obscure texture of the bone, hyperemia around the destructive bone tissue and in dura mater-like tissues, proliferation of interstitial fibrous tissue, swelling of endothelial cells and inflammatory infiltration predominantly composed of abundant plasma cells. After managed with routine treatment regimen for neurosyphilis, her headache was relieved 3 days later, nearly disappeared 15 days later, completely disappeared 30 days later. No similar headache recurred. A 5-year follow up demonstrated a satisfactory long-term and short-term outcome. She was finally diagnosed with syphilitic skull osteitis complicated by syphilitic meningitis.

Key words: syphilis