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A 12-year-old boy had a three-year history of exercise-induced pain in his limbs; in particular, the shoulders, elbows, and knees were affected. For six months he had also experienced loss of strength. He noted difficulty with walking and cycling and was hardly able to climb stairs. He developed toe walking and complained about an itchy skin rash with focal depigmentation at his neck and trunk, diagnosed as eczema. He did not complain about swallowing difficulty, yet he became cachexic because his nutritional intake was lagging, and he suffered from mood swings.
Previous history was unremarkable. His parents were healthy, as was his older brother.
To emphasise the importance of considering a diagnosis of early acquired syphilis in all sexually active adults, and to review the ENT manifestations and treatment of acquired syphilis.
Case report:
A 24-year-old woman presented with sudden hearing loss, and subsequently developed clinical features suggestive of secondary syphilis. She was seen in the departments of ENT, dermatology, rheumatology and infectious diseases before a correct diagnosis was made. Treatment resulted in only partial recovery of hearing.
Conclusions:
With the exponential rise in syphilis cases in the UK, there has been a re-emergence of presenting manifestations that had previously become rare. Early syphilis should be considered in all sexually active adults who present with deafness, as prompt diagnosis and treatment are crucial for maximum recovery.
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