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Gutierrez-Lanz E, Smith LB, Perry AM. Syphilis in Hematopathology Practice: A Diagnostic Challenge. Arch Pathol Lab Med 2024; 148:633-641. [PMID: 37535664 DOI: 10.5858/arpa.2023-0078-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 08/05/2023]
Abstract
CONTEXT.— Syphilis, a reemerging disease caused by the spirochete Treponema pallidum, is becoming more frequent in surgical pathology and hematopathology practices. Hematopathologists typically receive lymph node biopsies from patients with syphilis who have localized or diffuse lymphadenopathy. Occasionally, syphilis infection in the aerodigestive tract can show a prominent lymphoplasmacytic infiltrate and mimic lymphoma. Besides the varying and occasional atypical morphology, the fact that clinical suspicion tends to be low or absent when histologic evaluation is requested adds to the importance of making this diagnosis. OBJECTIVE.— To summarize histologic features of syphilitic lymphadenitis and syphilis lesions in the aerodigestive tract, and to review differential diagnosis and potential diagnostic pitfalls. DATA SOURCES.— Literature review via PubMed search. CONCLUSIONS.— Characteristic histologic findings in syphilitic lymphadenitis include thickened capsule with plasma cell-rich inflammatory infiltrate, reactive follicular and paracortical hyperplasia with prominent lymphoplasmacytic infiltrate, and vasculitis. Lymph nodes, however, can show a number of other nonspecific histologic features, which frequently makes the diagnosis quite challenging. In the aerodigestive tract, syphilis is characterized by plasma cell-rich infiltrates. Immunohistochemistry for T pallidum is the preferred method for detecting spirochetes; however, this immunohistochemical stain shows cross-reactivity with other treponemal and commensal spirochetes. Differential diagnosis of syphilis in lymph nodes and the aerodigestive tract is broad and includes reactive, infectious, and neoplastic entities. Pathologists should be aware of the histologic features of syphilis and keep this challenging entity in the differential diagnosis.
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Lv L, Liu G, Xu J, Luo J, Peng L, Ding Y, Shi W. Syphilitic proctitis: review of the literature. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2024. [PMID: 38469807 DOI: 10.17235/reed.2024.10334/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Syphilitic proctitis is a rare sexually transmitted disease caused by spirochete pallidum infecting the rectal mucosa. It usually has no specific clinical manifestations and is easily misdiagnosed with other rectal and anal diseases such as rectal cancer, malignant lymphoma, inflammatory bowel disease, etc.. Therefore, diagnosis of the disease is difficult and treatment options are often unreasonable. A case of syphilitic proctitis in our hospital with "rectal mass" as the main manifestation is reported as follows and relevant literature is reviewed. At the same time, we studied and analyzed the clinical and histological characteristics and differential diagnosis of syphilitic proctitis to further deepen the understanding of this disease.
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Affiliation(s)
- Liyuan Lv
- Gastroenterology, The Seventh Affiliated Hospital Sun Yat-sen University,
| | - Guinan Liu
- Gastroenterology, The Seventh Affiliated Hospital Sun Yat-sen University
| | - Jie Xu
- Pathological Diagnostic Center, The Seventh Affiliated Hospital Sun Yat-sen University
| | - Juncheng Luo
- Neurology, The Seventh Affiliated Hospital Sun Yat-sen University
| | - Ling Peng
- Neurology, The Seventh Affiliated Hospital Sun Yat-sen University
| | - Yiwei Ding
- Clinical Laboratory, The Seventh Affiliated Hospital Sun Yat-sen University
| | - Weiwen Shi
- Gastroenterology, The Seventh Affiliated Hospital Sun Yat-sen University
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Ola D, Dane B, Shanbhogue K, Smereka P. Rectal and perirectal CT findings in patients with monkeypox virus infection. Abdom Radiol (NY) 2023; 48:2284-2291. [PMID: 37148320 DOI: 10.1007/s00261-023-03933-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To analyze the findings of proctitis in patients with laboratory-confirmed Mpox and correlate the patient clinical presentation and laboratory findings. METHODS 21 patients with PCR-positive Mpox who obtained abdominopelvic CT were retrospectively identified by electronic medical record search. Three radiologists independently evaluated CT images, measuring rectal wall thickness (cm), degree of perirectal fat stranding on a 5-point Likert scale, and size of perirectal lymph nodes (cm, short axis). Mann-Whitney U-test (Wilcoxon rank sum test) was used to assess the association of rectal wall thickness and perirectal fat standing between patients with rectal symptoms and patients without rectal symptoms. RESULTS 20 of 21 patients presented with perirectal fat stranding, with mean Likert score of 3.0 ± 1.4, indicating moderate perirectal stranding. Mean transverse rectal wall thickness was 1.1 ± 0.5 cm (range 0.3-2.3 cm); it was thicker among patients with HIV (1.2 cm vs 0.7 cm; p = .019). Mean perirectal fat stranding was greater among patients presenting with HIV, and with rectal symptoms, though not significantly so. 17/21 (81%) patients had abnormal mesorectal lymph nodes by at least two of three readers, with mean short-axis measurement 1.0 ± 0.3 cm (range 0.5-1.6 cm). Multiple linear regression showed no significant correlation between rectal thickness and laboratory values or HIV status. CONCLUSION Nearly all patients with Mpox who presented with additional symptoms warranting a CT demonstrated proctitis. Degree of proctitis varied greatly within the cohort, with greatest thickening among patients with HIV. Physicians should have a high suspicion for proctitis in patients with suspected Mpox.
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Affiliation(s)
- David Ola
- Department of Radiology, NYU Langone Health, 660, 1st Avenue, New York, NY, 10016, USA
| | - Bari Dane
- Department of Radiology, NYU Langone Health, 660, 1st Avenue, New York, NY, 10016, USA
| | - Krishna Shanbhogue
- Department of Radiology, NYU Langone Health, 660, 1st Avenue, New York, NY, 10016, USA
| | - Paul Smereka
- Department of Radiology, NYU Langone Health, 660, 1st Avenue, New York, NY, 10016, USA.
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Peine B, Ved KJ, Fleming T, Sun Y, Honaker MD. Syphilitic proctitis presenting as locally advanced rectal cancer: A case report. Int J Surg Case Rep 2023; 107:108358. [PMID: 37267792 DOI: 10.1016/j.ijscr.2023.108358] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION Syphilis is an infectious disease that is uncommonly encountered in surgical patients. We present a case of severe syphilitic proctitis leading to large bowel obstruction with imaging findings mimicking locally advanced rectal cancer. PRESENTATION OF CASE A 38-year-old man who had sex with men presented to the emergency department with a 2 week history of obstipation. The patient's medical history was significant for poorly controlled HIV. Imaging demonstrated a large mass in the rectum and the patient was admitted to the colorectal surgery service for management of presumed rectal cancer. Sigmoidoscopy demonstrated a rectal stricture and biopsies showed severe proctitis without evidence for malignancy. Given the patient's history and discordant clinical findings an infectious workup was pursued. The patient tested positive for syphilis and was diagnosed with syphilitic proctitis. He underwent treatment with penicillin and although he experienced a Jarisch-Herxheimer reaction, his bowel obstruction completely resolved. Final pathology on the rectal biopsies demonstrated positive Warthin-Starry and spirochete immunohistochemical stain. DISCUSSION This case illustrates key aspects in the care of a patient with syphilitic proctitis mimicking an obstructing rectal cancer, including the need for high clinical suspicion, thorough evaluation including sexual and sexually transmitted disease history, multidisciplinary communication, and management of the Jarisch-Herxheimer reaction. CONCLUSION Severe proctitis leading to large bowel obstruction is a possible presentation of syphilis, and a high degree of clinical suspicion is necessary to be able to accurately identify the cause. An increased awareness of the Jarisch-Herxheimer reaction following treatment of syphilis is critical to provide appropriate care in this patient population.
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Affiliation(s)
- Brandon Peine
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, United States of America
| | - Kieran J Ved
- Brody School of Medicine, East Carolina University, Greenville, NC, United States of America
| | - Tyler Fleming
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, United States of America
| | - Ying Sun
- Department of Pathology, Brody School of Medicine, East Carolina University, Greenville, NC, United States of America
| | - Michael D Honaker
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, United States of America.
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Costales-Cantrell JK, Dong EY, Wu BU, Nomura JH. Syphilitic Proctitis Presenting as a Rectal Mass: a Case Report and Review of the Literature. J Gen Intern Med 2021; 36:1098-1101. [PMID: 33469766 PMCID: PMC8042098 DOI: 10.1007/s11606-020-06414-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/08/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Jessica K Costales-Cantrell
- Division of Infectious Diseases, University of California Irvine Medical Center, 101 City Drive South, City Tower Suite 400, Orange, CA, 92868, USA.
| | - Elizabeth Y Dong
- Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Bechien U Wu
- Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Jim H Nomura
- Division of Infectious Diseases, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
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Abstract
The incidence of syphilis is increasing. Syphilitic proctitis involving the rectal mucosa often presents with pain on defecation, rectal bleeding, or ulceration. We present a case of asymptomatic syphilitic proctitis diagnosed upon a routine screening colonoscopy.
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Tian M, Chang C, Wu P, Chen M. Diagnosis of syphilitic proctitis mimicking ulcerative colitis—A case report. ADVANCES IN DIGESTIVE MEDICINE 2019. [DOI: 10.1002/aid2.13165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ming‐Hung Tian
- Division of Gastroenterology and Hepatology, Department of Internal MedicineMacKay Memorial Hospital Taipei Taiwan
| | - Chen‐Wang Chang
- Division of Gastroenterology and Hepatology, Department of Internal MedicineMacKay Memorial Hospital Taipei Taiwan
- Department of NursingMacKay Junior College of Medicine, Nursing, and Management Taipei Taiwan
- Department of MedicineMacKay Medical College New Taipei City Taiwan
| | - Pao‐Shu Wu
- Department of PathologyMacKay Memorial Hospital Taipei Taiwan
| | - Ming‐Jen Chen
- Division of Gastroenterology and Hepatology, Department of Internal MedicineMacKay Memorial Hospital Taipei Taiwan
- Department of NursingMacKay Junior College of Medicine, Nursing, and Management Taipei Taiwan
- Department of MedicineMacKay Medical College New Taipei City Taiwan
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Abstract
Syphilis, a sexually transmitted infection caused by the Gram-negative bacterium Treponema pallidum, is increasing in prevalence in the United States. It has been our experience that primary and secondary syphilis of the aerodigestive tract can afflict a large age spectrum with varied clinical and histopathologic findings, which can lead to diagnostic problems and frequent misdiagnosis. In this study, we describe the histopathologic patterns of syphilis of the aerodigestive tract to expand awareness of its varied appearance. We identify 3 patterns of inflammatory response to syphilis: plasma cell-rich, lymphohistiocytic, and lymphoma-like. We also report the presence of immunoglobulin G4-predominant plasma cells in the inflammatory response as a potential mimicker of immunoglobulin G4-related disease. Lastly, we found that use of T. pallidum immunohistochemical stain is more reliable than Steiner silver stain at the identification of spirochetes. Our study highlights that despite convention, plasma cells are not always abundant in syphilis. Awareness of the histopathologic range of syphilis in the aerodigestive tract by the surgical pathologist can lead to the correct diagnosis and guide appropriate treatment.
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Guzman Rojas P, Catania J, Parikh J, Phung TC, Speth G. Intestinal Spirochetosis in an Immunocompetent Patient. Cureus 2018; 10:e2328. [PMID: 29770281 PMCID: PMC5953507 DOI: 10.7759/cureus.2328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Intestinal spirochetosis (IS) is an infestation defined by the presence of spirochetes on the surface of the colonic mucosa. The implicated organisms can be Brachyspiraaalborgior Brachyspirapilosicoli. We present the case of a 66-year-old man with a past medical history of diabetes mellitus, hypertension, morbid obesity, and gastroesophageal reflux. The patient was sent to the gastroenterology clinic for a screening colonoscopy due to a prior history of colonic polyps. The patient was completely asymptomatic as he denies any abdominal pain, diarrhea, melena, or hematochezia. A colonoscopy was done showing colitis in the cecum and at the ileocecal valve, for which random biopsies were taken in the terminal ileum, cecum, and ascending colon. The histopathology result was positive for spirochetosis. Due to this finding, the patient was referred to the infectious diseases clinic, where a rapid plasma reagin (RPR) and human immunodeficiency virus (HIV) tests were found to be negative. Since the patient was immunocompetent and asymptomatic, it was decided to monitor and not initiate antibiotic treatment. Human IS are not related to non-intestinal spirochetes like Treponema pallidum. An infection of T. pallidum leads to a malignant picture called syphilitic proctitis and appears in the setting of an immunocompromised patient. The treatment of IS is based on the clinical presentation, severity of symptoms, and immune status. The purpose of this case is to emphasize the correct antibiotic indication in patients with IS.
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Affiliation(s)
| | - Jelena Catania
- Infectious Diseases, Orlando Va Medical Center, UCF Com/hca Gme Consortium's Internal Medicine Residency Program
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