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Heavy Metal Injection Granulomas: A Source of Diagnostic Confusion A Composite Case Report
Junichi Tamai, MD; James A. Shaw, MD
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Investigation performed at The George Washington University Medical Center, Washington, D.C.

Junichi Tamai, MD
Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19034

James A. Shaw, MD
7817 Tomlinson Avenue, Cabin John, MD 20818

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

J Bone Joint Surg Am, 2002 May 01;84(5):800-803
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Prior to the introduction of penicillin in the 1940s, syphilis was treated primarily with heavy metal injections. Once commonplace, the characteristic gluteal injection deposits visible on radiographs are now seen only occasionally and, therefore, may result in a diagnostic enigma to younger orthopaedic surgeons. An informal survey of orthopaedic residents and younger faculty members at our institution who were asked to identify the radiopaque deposits seen in Figures 1-A , 1-B , 1-C , and 1-D ) revealed a 0% recognition rate. Since patients with a history of syphilis who were originally treated with heavy metal injections still are seen on occasion by an orthopaedic surgeon, it is important that younger orthopaedists become reacquainted with the characteristic radiographic appearance of these injection granulomas.
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