Tabetic Arthropathy: A Historical Multiple Localization

Abstract

Tabetic arthropathy is a rare complication of neurosyphilis. It has currently become rare due to the decreased frequency of syphilis and early treatment. We report a case of tabetic arthropathy with multiple localizations. The patient is a 67-year-old individual with no particular medical history. He was hospitalized for painless deformities of both knees and the right elbow, which had been progressing for 25 years, accompanied by the sudden onset of swelling in the left knee, progressing with remission. Later, he developed similar swelling in the right knee and elbow. Subsequently, he experienced progressive and painless instability in both knees, resulting in total functional disability. Standard X-rays of the right elbow, both knees, and the left hand revealed significant joint destruction. Given the discrepancy between the extent of radiological destruction and the painlessness of the affected joint arthropathy, the diagnosis of neurogenic arthropathy was considered. Serology for syphilis was positive (TPHA + and VDRL -) in both blood and cerebrospinal fluid. The diagnosis of polyarticular tabetic arthropathy was confirmed. The patient was treated with a third-generation cephalosporin at a dose of 2g per day intravenously for 21 days. This is a rare case of late-diagnosed multifocal tabetic arthropathy with a catastrophic outcome.