Traveling Companions
Abstract
A 29-year-old man presented with fever, migratory arthritis, and a nonpruritic rash after recent injection drug use and unprotected sex with male partners. Initial workup revealed secondary syphilis, but abrupt worsening joint pain led to a second diagnosis septic arthritis caused by methicillin-resistant Staphylococcus aureus (MRSA). The case underscores the need to avoid premature diagnostic closure and to recognize syphilis’s varied presentations and the infection risks linked to injection drug use. It also explores antibiotic and surgical management, including the use of dalbavancin as an alternative to prolonged IV therapy in high-risk populations.
Keywords:
syphilis
septic arthritis
MRSA
injection drug use
clinical reasoning
dalbavancin
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