The Higoumenakis sign is the unilateral enlargement of the sternal end of the clavicle in patients with late congenital syphilis. It was originally described as a clinical sign on physical examination but can also be recognized on chest radiograph 5.
Treponema pallidum becomes readily localized in the lymphatic spaces and may remain in the connective tissues without manifestation in childhood. Through mechanical movement of the dominant hand of the patient, the treponemata are reactivated and their toxins produce chronic periostitis which results in hyperostosis.
History and etymology
Described in 1927 by Gregorios "George" Higoumenakis (1895-1983), Greek dermatologist 3.
- 1. Frangos CC, Lavranos GM, Frangos CC. Higoumenakis' sign in the diagnosis of congenital syphilis in anthropological specimens. Med. Hypotheses. 2011;77 (1): 128-31. doi:10.1016/j.mehy.2011.03.044 - Pubmed citation
- 2. Frangos CC, Frangos CC. George Higoumenakis (1895-1983): Greek dermatologist. J Med Biogr. 2009;17 (2): 64-72. doi:10.1258/jmb.2009.009005 - Pubmed citation PDF
- 3. Higoumenakis KG. Higoumenakis's sign and its significance for the diagnosis of congenital syphilis. Dermatol Wochenschr. 1969;154 (30): 697-705. Pubmed citation [ Article in German ]
- 4. Jurik AG, De Carvalho A, Graudal H. Sclerotic changes of the sternal end of the clavicle. Clin Radiol. 1985;36 (1): 23-5. Pubmed citation PDF
- 5. L. Grant Glickman, Armen A. Minsky. Enlargement of One Sternoclavicular Articulation: A Sign of Congenital Syphilis1. (1937) Radiology. doi:10.1148/28.1.85