Case Reports Radionuclide Imaging in a Case of Tertiary SyphilisInvolving the Liver and Bones

Tertiary syphilis is an unusual entity. We have encountered a case of tertiary syphilis of the liver and bone demonstrated by scintigraphy. With liver involvement, the liver scan showed focal defects due to gummas, and distortion due to scarring. Bone involvement was shown as increased cortical activity from periostitis, focal hot spots due to osteomyelitis, and cold defects due to gumma formation. Because syphilis is easily treated, but may not be as readily recognized, the diagnosis should be considered in cases of focal liver or bone disease of obscure etiology. J NucÃ-Med 28:1047-1051,1987 kjyphilis can be a chronic infectious disease; its diag nosis is often overlooked and it may affect many organ systems. Therefore, improved recognition of its mani festations with newer techniques, such as scintigraphy, becomes important. Radionuclide findings in tertiary syphilis have not been reported previously and there are only a few references in the literature dealing with the scintigraphic appearance of earlier forms of acquired syphilis. The following case report illustrates some find ings of tertiary syphilis in a patient with bone and liver involvement demonstrated by scintigraphy. CASE REPORT A 39-yr-old male patient presented with an 8-mo history of back and right shoulder pain accompanied by 20-lb weight loss. Initial radiographs demonstrated multiple lytic and bias-tic lesions of the spine at T5, T10, TI 1, L3, L5, sacrum, and left ilium; destruction of the right glenoid was also noted (Fig. 1). He was admitted for workup of presumed metastatic carcinoma. Twenty years earlier, the patient had undergone orchiec-tomy for an undescended testicle and had been treated for urethritis with an unknown antibiotic. On admission the patient was afebrile; physical examina tion revealed a liver span of 14 cm with a palpable spleen tip. Percussion tenderness over L3 was present. There were n