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Traveling Companions
Article Number: SIS137648AI220525
22nd May, 2025
Author(s):
Rachel K. Gardner, M.D.; Daniel A. Solomon, M.D.; Allison S. Bloom, M.D.; Yee-Ping Sun, M.D.; Bruce D. Levy, M.D.
Abstract:
This clinical problem-solving case discusses a 29-year-old man who presented with fever, chills, and joint pain, revealing an unusual dual diagnosis of secondary syphilis and methicillin-resistant Staphylococcus aureus (MRSA) septic arthritis.
The patient had risk factors, including injection-drug use and multiple male sexual partners, raising concern for sexually transmitted infections (STIs) and injection-related infections. Initially, his fever, polyarthritis, and rash suggested disseminated syphilis or reactive arthritis, but worsening joint pain led to further testing, uncovering purulent synovial fluid containing MRSA a sign of septic arthritis requiring urgent treatment.
The case illustrates diagnostic challenges, highlighting how syphilis is the "great imitator" due to its variable migratory polyarthritis and systemic manifestations, while septic arthritis necessitates prompt recognition to prevent irreversible joint damage.
Treatment involved penicillin for syphilis and vancomycin, then dalbavancin, for MRSA. The patient recovered without long-term complications.