A case of Clutton's joints or chronic synovitis as a late manifestation of congenital syphilis is presented. Progressive patchy periostitis and interstitial keratitis were also present in this 19-year-old-Negro girl. All three manifestations of the disease and the serology were apparently unaffected by penicillin therapy. The histology of the synovium is presented and illustrated. Es presentate un caso de articulationes de Clutton, o de chronic synovitis, como manifestation tardive de syphilis congenite. Progressive periosititis maculose e ceratitis interstitial esseva etiam presente in iste negressa de 19 annos de etate. Omne le tres manifestationes del morbo e le serologia esseva apparentemente non afficite per therapia a penicillina. Le histologia del synovio es presentate e illustrate. HRONIC SYNOVITIS occurring in the course of late congenital syphilis C was first reported in detail by Cluttonl in 1886. He described 11 cases of insidious synovitis, usually of the knee. Subsequently, other authors2-' have reported numerous cases of chronic intermittent hydrarthrosis associated with congenital syphilis, usually running a benign course without producing joint damage.
This report presents a case of Clutton's joints with interstitial keratitis and periostitis which was unresponsive to penicillin therapy. Histology of the synovium has been described in the literatures and is here further illustrated.
CASE REPORT
J. R., a 19-year-old Negro girl, was admitted to the E. J. Meyer Memorial Hospital in November, 1961, because of pain in the legs and swelling of the left knee. The onset of symptoms began 4 months prior to admission, with left anterior tibial pain followed by right anterior tibial pain. Swelling and tenderness occurred in the left knee about 1 month before admission. Because of persistence of symptoms she was referred to the hospital. The patient's past history did not reveal pervious joint disease, acquired venereal diseases or other serious illnesses. The only other pertinent history was that her father was treated for syphilis in 1941. On initial examination she had a temperature of 100.2 F. and leg pains. The left knee was warm and tender, with effusion and synovial thickening. Range of motion could be performed from 70" to 170" with only mild pain. Both anterior tibial areas had markedly tender periosteal nodules. The remainder of the physical examination was not revealing. Laboratory examinations on admission showed a normal hematocrit, white blood cell count, differential count and urinalysis. Other studies which were normal include blood From the Department of Medkiw, State Universitg of N e w Yotk at Buffalo, and The