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Sinagra E, Macaione I, Stella M, Shahini E, Maida M, Pompei G, Rossi F, Conoscenti G, Alloro R, Di Ganci S, Ricotta C, Testai S, Marasà M, Scarpulla G, Rizzo AG, Raimondo D. Gastric Syphilis Presenting as a Nodal Inflammatory Pseudotumor Mimicking a Neoplasm: Don’t Forget the Treponema! Case Report and Scoping Review of the Literature of the Last 65 Years. GASTROENTEROLOGY INSIGHTS 2023. [DOI: 10.3390/gastroent14020014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Despite the fact that gastric syphilis is considered rare, it is reported as a type of organic involvement that is present in a large proportion of secondary syphilis cases, even though gastritis presenting with symptoms is extremely rare. Clinical, radiological, and endoscopic findings are non-specific and frequently mimic the symptoms of gastric adenocarcinoma or lymphoma, making diagnosis difficult. Immunostaining is required for this diagnosis. We would like to emphasize the importance of being suspicious of GS when a gastric mass exhibits the histologic features of an inflammatory pseudotumor (IPT), as previously reported for nodal IPT caused by luetic infection. We described a 56-year-old man who presented to the oncology department with a 3-month history of anorexia, epigastric pain, nausea, vomiting, and weight loss, as well as an initial radiological and endoscopic suspicion of gastric adenocarcinoma, in which immune staining allowed us to diagnose GS. In addition, we conducted an updated scoping review of the scientific literature to show the clinical, laboratory, and therapeutic findings in GS patients over the last 65 years.
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Affiliation(s)
- Emanuele Sinagra
- Gastroenterology & Endoscopy Unit, Fondazione Istituto Gemelli–G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy
| | - Ina Macaione
- Mini-Invasivecolorectal & Pancreatic Surgery Unit, Fondazione Istituto Gemelli–G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy
| | - Mario Stella
- Pathology Unit, Az. Osp. Ospedali Riuniti “Villa Sofia-Cervello”, Via Trabucco 180, 90146 Palermo, Italy
| | - Endrit Shahini
- Gastroenterology Unit, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, Castellana Grotte, 70013 Bari, Italy
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, 93100 Caltanissetta, Italy
| | - Giancarlo Pompei
- Pathology Unit, Sant’Antonio Abate Hospital, Via Cosenza 82, 91016 Casa Santa, Italy
- Pathology Unit, Fondazione Istituto Gemelli–G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy
| | - Francesca Rossi
- Gastroenterology & Endoscopy Unit, Fondazione Istituto Gemelli–G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy
| | - Giuseppe Conoscenti
- Gastroenterology & Endoscopy Unit, Fondazione Istituto Gemelli–G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy
| | - Rita Alloro
- Gastroenterology & Endoscopy Unit, Fondazione Istituto Gemelli–G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy
| | - Simona Di Ganci
- Mini-Invasivecolorectal & Pancreatic Surgery Unit, Fondazione Istituto Gemelli–G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy
| | - Calogero Ricotta
- Mini-Invasivecolorectal & Pancreatic Surgery Unit, Fondazione Istituto Gemelli–G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy
| | - Sergio Testai
- Radiology Unit, Fondazione Istituto Gemelli–G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy
| | - Marta Marasà
- Radiology Unit, Fondazione Istituto Gemelli–G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy
| | - Giuseppe Scarpulla
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, 93100 Caltanissetta, Italy
- Radiology Unit, Fondazione Istituto Gemelli–G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy
| | - Aroldo Gabriele Rizzo
- Pathology Unit, Az. Osp. Ospedali Riuniti “Villa Sofia-Cervello”, Via Trabucco 180, 90146 Palermo, Italy
| | - Dario Raimondo
- Gastroenterology & Endoscopy Unit, Fondazione Istituto Gemelli–G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy
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Yu HJ, Kim SJ, Oh HH, Im CM, Han B, Myung E, Yun SJ, Lee KH, Joo YE. Case report of gastric syphilis in Korea: Clinical features, pathology, management, and prognosis. Medicine (Baltimore) 2021; 100:e28212. [PMID: 34918682 PMCID: PMC8678019 DOI: 10.1097/md.0000000000028212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/22/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Syphilis is a contagious infectious disease caused by Treponema pallidum. Gastric involvement of syphilis is rare and has nonspecific gastrointestinal symptoms and endoscopic findings. To date, 16 cases have been reported in Korea. Here, we report 2 additional cases of gastric syphilis in men in their 30 second. PATIENTS CONCERNS Two 35- and 33-year-old men presented with epigastric pain. DIAGNOSIS The serum venereal disease research laboratory and fluorescent treponemal antibody absorption tests were positive. Esophagogastroduodenoscopy showed multiple variable-sized flat elevated lesions and geographic ulcers with whitish exudates in the antrum and body. Warthin-Starry silver staining of endoscopic biopsy specimens confirmed gastric syphilis. INTERVENTIONS The patients were treated with an intramuscular injection of 2.4 million units of benzathine penicillin once a week for 3 weeks. OUTCOMES Clinical symptoms and gastric lesions were completely resolved. LESSONS First, gastric syphilis, despite its rarity and nonspecific symptoms and endoscopic findings, should be considered in a rare extracutaneous presentation of syphilis. Second, a high index of clinical suspicion and an accurate diagnosis based on a combination of clinical, radiological, endoscopic, serologic, and histopathologic findings provide an opportunity to identify and treat patients with gastric syphilis.
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Affiliation(s)
- Hyung-Joo Yu
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seong-Jung Kim
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Republic of Korea
| | - Hyung-Hoon Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Chan-Mook Im
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Bora Han
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Eun Myung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sook-Jung Yun
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Kyung-Hwa Lee
- Department of Pathology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Young-Eun Joo
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
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Szafron D, Kim HS, Turin CG, Benzi E, Khalaf N, Hernaez R. Duodenal and liver lesions in an adult with generalised weakness. Gut 2020; 69:1-2. [PMID: 31542773 DOI: 10.1136/gutjnl-2019-319561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/06/2019] [Accepted: 09/08/2019] [Indexed: 12/08/2022]
Affiliation(s)
- David Szafron
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Hyun-Seok Kim
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA.,Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - Christie G Turin
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Eduardo Benzi
- Department of Pathology, Baylor College of Medicine, Houston, Texas, United States
| | - Natalia Khalaf
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA.,Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA.,Gastroenterology and Hepatology, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Ruben Hernaez
- Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA.,Gastroenterology and Hepatology, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Houston VA Health Services Research and Development Center of Excellence, Michael E Debakey Veterans Affairs Medical Center, Houston, Texas, United States
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Gremida A, Adnan M, Kappor V, Harji F, Glass J, McCarthy D. Dyspepsia, Diarrhea, and Deafness: Some Calling Cards of the Great Mimic! Dig Dis Sci 2017; 62:2994-2998. [PMID: 29027599 DOI: 10.1007/s10620-017-4793-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/05/2017] [Indexed: 12/09/2022]
Affiliation(s)
- Anas Gremida
- Division of Gastroenterology and Hepatology, University of New Mexico School of Medicine, MSC 10-5550, 1 University of New Mexico, Albuquerque, NM, USA.
| | - Muqeet Adnan
- Division of Gastroenterology and Hepatology, University of New Mexico School of Medicine, MSC 10-5550, 1 University of New Mexico, Albuquerque, NM, USA
| | - Vidit Kappor
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Farzana Harji
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Joseph Glass
- Department of Pathology, VA Medical Center, Albuquerque, NM, USA
| | - Denis McCarthy
- Division of Gastroenterology and Hepatology, University of New Mexico School of Medicine, MSC 10-5550, 1 University of New Mexico, Albuquerque, NM, USA
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Abstract
Awareness of the spectrum of clinical manifestations of syphilis, especially uncommon changes, is essential for diagnosis and effective management of patients. A 48-year-old Han businessman presented to the ear, nose and throat surgeons with an eight-week history of epigastric pain, a four-week history of a widespread non-itchy rash including the scrotal skin and a one-week history of tinnitus and dizziness. On examination, he was afebrile with widespread lymphadenopathy and a maculopapular rash affecting his trunk and scrotum. His abdomen was soft but tender in the epigastrium. The Treponema pallidum particle agglutination assay result was positive, and the rapid plasma reagin was 1:2. Gastroscopy showed ulcers in the gastric antrum and pylorus. Histopathological examination of gastric mucosa lesions showed a large amount of lymphoplasmacytic infiltrate detected in the lamina propria of the gastric mucosa. The T. pallidum Liferiver real time polymerase chain reaction kit assay performed on specimens from skin lesions and gastric mucosal tissue were positive. The patient was treated with intravenous sodium penicillin followed by intramuscular benzathine penicillin. On the fourth day of the treatment, the rash, epigastric pain and lymphadenopathy subsided. Two weeks after treatment, the tinnitus alleviated and vertigo disappeared.
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Affiliation(s)
- Kuan Lai
- 1 Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | | | | | - Shanshan Wei
- 1 Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Kang Zeng
- 1 Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
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6
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Guimarães TF, Novis CFL, Bottino CB, D'Acri AM, Lima RB, Martins CJ. Gastric syphilis - Case report. An Bras Dermatol 2017; 91:670-672. [PMID: 27828649 PMCID: PMC5087234 DOI: 10.1590/abd1806-4841.20164174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 01/25/2015] [Indexed: 11/29/2022] Open
Abstract
Gastric syphilis is an uncommon extracutaneous manifestation of syphilis,
occurring in less than 1% of patients, presenting nonspecific clinical
manifestations. In general, it occurs on secondary stage. The critical point is
the recognition of the syphilitic gastric involvement, without which there may
be incorrect diagnosis of malignancy of the digestive tract. In this report, a
case of secondary syphilis with gastric involvement that had complete remission
with benzathine penicillin will be described.
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Affiliation(s)
| | | | | | - Antonio Macedo D'Acri
- Universidade Federal do Estado do Rio de Janeiro (UniRio) - Rio de Janeiro (RJ), Brazil
| | - Ricardo Barbosa Lima
- Universidade Federal do Estado do Rio de Janeiro (UniRio) - Rio de Janeiro (RJ), Brazil
| | - Carlos José Martins
- Universidade Federal do Estado do Rio de Janeiro (UniRio) - Rio de Janeiro (RJ), Brazil
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Ferreira-González L, Rubin EP, Álvarez-Fernández JC, Caínzos-Romero T. [Syphilitic gastritis: an aetiology to consider]. Enferm Infecc Microbiol Clin 2011; 30:105-7. [PMID: 22195974 DOI: 10.1016/j.eimc.2011.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 10/31/2011] [Accepted: 11/02/2011] [Indexed: 12/01/2022]
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Abstract
The authors conducted a systematic review of the English literature for cases of Gastric Syphilis (GS) in the last 50 years. The 34 studies which met selection criteria included 52 patients with GS. Of the reviewed patients, only 13% had a history of syphilis diagnosis and 46% had prior or concurrent clinical manifestations of the disease. Epigastric pain/fullness was the most common presenting symptom (92%) and epigastric tenderness being the most common sign. Gastric bleeding of variable intensity was documented in 35% of the cases. In the radiologic examinations, fibrotic narrowing and rigidity of the gastric wall was the most common finding (43%), followed by hypertrophic and irregular folds, while in endoscopy the most common lesion types were multiple ulcerations (48%), nodular mucosa, and erosions. The antrum was the most commonly affected area (56%). The majority of the patients received penicillin (83%) with a rapid resolution of their symptoms. Seventeen percent of the patients were treated surgically either due to a complication or due to strong suspicion of infiltrating tumor or lymphoma. The nonspecific clinical, radiologic, and pathologic characteristics of GS can establish it as a great imitator of other gastric diseases. GS should be considered in the differential diagnosis in patients at risk for sexually transmitted diseases who present with abdominal complaints and unusual endoscopic lesions and no other diagnosis is made, irrespective of the presence of H. pylori. The absence of primary or secondary luetic lesions should not deter one from considering GS.
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Kim K, Kim EJ, Kim MJ, Song HJ, Lee YS, Jung KW, Yu E. Clinicopathological features of syphilitic gastritis in Korean patients. Pathol Int 2009; 59:884-9. [PMID: 20021615 DOI: 10.1111/j.1440-1827.2009.02462.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Syphilitic gastritis is difficult to diagnose without a history of syphilis, because endoscopic and microscopic findings can simulate gastric cancer or lymphoma. Herein are reported two cases of syphilitic gastritis and analysis of the clinicopathological characteristics of 11 cases in Korean subjects, including nine previously reported ones. The two present patients were 25- and 32-year-old men with epigastric pain. The gastroduodenoscopy features were similar: multiple erosive or ulcerative lesions in whole gastric mucosa. Microscopically, gastric mucosa contained severe chronic active gastritis involving submucosa with crypt abscesses, venulitis and granulomas, suggesting unusual infectious gastritis. Numerous spirochetes were identified on silver staining, and serological tests for syphilis were reactive in both patients. They were treated with benzathin penicillin, and follow-up gastric biopsy specimens indicated non-specific chronic gastritis without evidence of syphilis. Of the 11 Korean patients with syphilitic gastritis, six were female and five were male (mean age, 31.7 years). The most common symptom was epigastric pain and all patients had diffuse erosive, ulcerative or infiltrative lesions on gastroduodenoscopy. Syphilitic gastritis should be considered in young patients with epigastric pain who have diffuse gastric involvement such as erosion or shallow ulcer on endoscopy and unusually extensive chronic active gastritis on microscopy, even if the history of syphilis is not clear.
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Affiliation(s)
- Kyungeun Kim
- Departments of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Thébault S, Danjoux M, Mejdoubi S, Agadi Y, Alric L. Syphilis revealed by a severe gastric injury. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2009; 33:1072-1073. [PMID: 19272724 DOI: 10.1016/j.gcb.2008.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Revised: 09/19/2008] [Accepted: 10/03/2008] [Indexed: 05/27/2023]
Affiliation(s)
- S Thébault
- Service de médecine interne, pôle digestif, CHU Purpan, Toulouse cedex, France
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