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Bronte Viedma A, Menendez-Sanchez S, Bastidas Tamayo JF, Lajusticia Andrés H, García-Velloso MJ. Syphilis Mimicking Malignant Pulmonary Tumor With Nodal and Bone Metastasis on 18 F-FDG PET/CT. Clin Nucl Med 2023; 48:e526-e528. [PMID: 37796159 DOI: 10.1097/rlu.0000000000004836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
ABSTRACT A 52-year-old man suffering left pleuritic pain underwent a chest CT showing a subpleural pulmonary nodule in the left upper lobe. Because of the possibility of a lung tumor, he was referred for 18 F-FDG PET/CT. The scan revealed FDG uptake in the pulmonary nodule, in an upper right paratracheal lymph node, and at 4 destructive bone lesions. Pathologic examination after pulmonary biopsy manifested only the presence of inflammatory cells. Further clinical history research proved risky sexual behavior with a positive syphilis serology test. A follow-up PET/CT 7 months after penicillin therapy showed a complete metabolic response of all the lesions.
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2
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Khan M, Sharma A, Hathorn T, Sandhu M, Rosen R, Riddle N, Mifsud M. The Mucosal Manifestations of Syphilis in the Head and Neck. EAR, NOSE & THROAT JOURNAL 2023:1455613231165159. [PMID: 37129418 DOI: 10.1177/01455613231165159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Objectives: Syphilis is a resurging disease which can present itself in many ways, including lesions within the head and neck mucosa. Some of these lesions may clinically mimic oral malignancies. This literature review aims to better characterize the mucosal presentations of syphilis. Methods: PubMed, EMBASE, and clinicaltrials.gov were searched for full-text, English articles published from 1950 to 2022 that reported patients with head and neck mucosal manifestations of syphilis. Articles were screened according to PRISMA guidelines. Results: One hundred forty-three manuscripts documenting 236 individual patients were included in the review. Patients with secondary syphilis accounted for 62% of patients presenting with head and neck mucosal lesions. The most common lesions found in primary and secondary syphilis were ulcerations, primarily found on the tongue, lips, and palate. While serologic studies are the gold standard for diagnosing syphilis, biopsy of these lesions have characteristic syphilitic changes. Conclusions: Syphilis' nickname of "The great imitator" remains to be true, and the head and neck mucosal manifestations of this disease can resemble commonly seen malignancies. Awareness of this disease and its lesions is prudent given the rising incidence of syphilis within the United States.
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Affiliation(s)
- Mahnoor Khan
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Abhay Sharma
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Travis Hathorn
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Mannat Sandhu
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Ross Rosen
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Nicole Riddle
- Department of Pathology and Cell Biology, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Matthew Mifsud
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
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3
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Yang X, Wu W, Wang Y, Wu W, Huang X, Xu L. A Case of Secondary Pulmonary Syphilis - The Utility of mNGS in Bronchoalveolar Lavage Fluid: A Case Report. Infect Drug Resist 2022; 15:5215-5219. [PMID: 36090605 PMCID: PMC9462547 DOI: 10.2147/idr.s373711] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Syphilis is a sexually transmitted infectious disease caused by Treponema pallidum. Here, we report a rare case of secondary pulmonary syphilis, which was diagnosed by metagenomic next-generation sequencing (mNGS) in bronchoalveolar lavage fluid (BALF). Direct pulmonary involvement by T. pallidum was suggested by a positive mNGS result in BALF. One month after treatment with benzathine penicillin G (2.4 million units, three doses), a repeated CT scan showed the radiological resolution. To our knowledge, this is the first reported case of secondary pulmonary syphilis diagnosed by mNGS in BALF.
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Affiliation(s)
- Xue Yang
- Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, People's Republic of China
| | - Weigang Wu
- Department of Infectious Disease, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, People's Republic of China
| | - Yongjie Wang
- Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, People's Republic of China
| | - Wen Wu
- Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, People's Republic of China
| | - Xia Huang
- Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, People's Republic of China
| | - Li Xu
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, People's Republic of China
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4
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Jakobsen JK, Szumniak J, Stilling C, Fledelius J, Bouchelouche K. FDG PET/CT in a Patient With Syphilis Suspected of Having Penile Cancer. Clin Nucl Med 2022; 47:e621-e623. [PMID: 35930717 DOI: 10.1097/rlu.0000000000004170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 58-year-old man with large penile wound and enlarged regional lymph node was suspected of having disseminated penile cancer. FDG PET/CT for primary staging showed high FDG uptake on penis and in several enlarged lymph nodes. However, biopsies revealed no signs of malignancy, but ulceration, inflammation, fibrosis, and spirochetes. Furthermore, Wassermann test was positive. The patient was then treated for syphilis. To our knowledge, this is the first report on FDG PET/CT in a patient suspected of having penile cancer that turned out to be syphilis. Thus, syphilis can be added to the list of benign pitfalls in FDG PET/CT.
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Affiliation(s)
| | - Joanna Szumniak
- Department of Dermatology and Venereology, Aalborg University Hospital, Aalborg
| | | | - Joan Fledelius
- Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
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5
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Hermida-Lama E, Marco-Hernández J, Medaglia AA, Pagès M, Vollmer I, Ramírez J, Martínez D, Mallolas J, García F. Cholangitis and pulmonary nodules in a clinical presentation of syphilis in an HIV-infected patient. Int J STD AIDS 2019; 30:820-824. [PMID: 31046616 DOI: 10.1177/0956462418823386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Several clinical manifestations attributed to syphilitic infection have been described in the literature. This is important because of the increased incidence of this infection mainly among men who have sex with men. We report the case of an HIV-infected patient who was hospitalized due to severe cholestasis, initially interpreted as drug-induced liver disease. It evolved slowly, with increasing intrahepatic cholangitis confirmed by magnetic resonance cholangiography and the appearance of several pulmonary nodules. In lung and liver biopsies, the presence of Treponema pallidum was detected by molecular and immunohistochemistry techniques, and a diagnosis of cholangitis and pulmonary syphilis was made.
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Affiliation(s)
- Evelyn Hermida-Lama
- 1 Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Alice Annalisa Medaglia
- 1 Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain.,2 Infectious Diseases Department, Policlinico P. Giaccone, Palermo, Italy
| | - Mario Pagès
- 3 Radiology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ivan Vollmer
- 3 Radiology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Josep Ramírez
- 4 Pathology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Daniel Martínez
- 4 Pathology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Josep Mallolas
- 1 Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain.,5 AIDS Research Group, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Felipe García
- 1 Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain.,5 AIDS Research Group, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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6
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Wang LJ, Wu HB, Zhou WL, Yu SR, Wang QS. Gummatous Syphilis Mimicking Malignant Bone Tumor on FDG PET/CT. Clin Nucl Med 2019; 44:313-316. [PMID: 30672757 DOI: 10.1097/rlu.0000000000002450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 47-year-old woman suffered worsening pain in the waist and numbness in the right thigh for 1 month. MRI was performed to determine the cause, which detected an osteolytic lesion in the T12 vertebral body, suggestive of possible bone metastasis. FDG PET/CT scan was undertaken to detect the primary tumor, which only showed the same isolated lesion in the T12 without any other abnormal hypermetabolic lesion. The pathology following vertebrectomy revealed granulomatous infection. The diagnosis of osseous syphilis was eventually made following a subsequent positive Treponema pallidum serological test.
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Affiliation(s)
- Li-Juan Wang
- From the PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
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7
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Komeno Y, Ota Y, Koibuchi T, Imai Y, Iihara K, Ryu T. Secondary Syphilis with Tonsillar and Cervical Lymphadenopathy and a Pulmonary Lesion Mimicking Malignant Lymphoma. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:238-243. [PMID: 29502129 PMCID: PMC5846205 DOI: 10.12659/ajcr.907127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patient: Male, 27 Final Diagnosis: Secondary syphilis Symptoms: Fever • loss of appetite • neck mass • night sweats • weight loss Medication: Oral amoxicillin Clinical Procedure: Lymph node biopsy Specialty: Infectious Diseases
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Affiliation(s)
- Yukiko Komeno
- Department of Hematology, Japan Community Healthcare Organization (JCHO), Tokyo Yamate Medical Center, Tokyo, Japan
| | - Yasunori Ota
- Department of Diagnostic Pathology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Tomohiko Koibuchi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yoichi Imai
- Department of Hematology and Oncology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Kuniko Iihara
- Department of Pathology, Japan Community Healthcare Organization (JCHO), Tokyo Yamate Medical Center, Tokyo, Japan
| | - Tomiko Ryu
- Department of Hematology, Japan Community Healthcare Organization (JCHO), Tokyo Yamate Medical Center, Tokyo, Japan
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8
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Chen JH, Zheng X, Liu XQ. Usefulness of Positron Emission Tomography in Patients with Syphilis: A Systematic Review of Observational Studies. Chin Med J (Engl) 2018; 130:1100-1112. [PMID: 28469107 PMCID: PMC5421182 DOI: 10.4103/0366-6999.204940] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Diagnosis of syphilis is difficult. Follow-up and therapy evaluation of syphilitic patients are poor. Little is known about positron emission tomography (PET) in syphilis. This review was to systematically review usefulness of PET for diagnosis, disease extent evaluation, follow-up, and treatment response assessment in patients with syphilis. Methods: We searched PubMed, EMBASE, SCOPUS, Cochrane Library, Web of Science, ClinicalTrials.gov, and three Chinese databases (SinoMed, Wanfang, and CNKI) for English and Chinese language articles from inception to September 2016. We also collected potentially relevant studies and reviews using a manual search. The search keywords included the combined text and MeSH terms “syphilis” and “positron emission tomography”. We included studies that reporting syphilis with a PET scan before and/or after antibiotic treatment. The diagnosis of syphilis was based on serological criteria or dark field microscopy. Outcomes include pre- and post-treatment PET scan, pre- and post-treatment computed tomography, and pre- and post-treatment magnetic resonance imaging. We excluded the articles not published in English or Chinese or not involving humans. Results: Of 258 identified articles, 34 observational studies were included. Thirty-three studies were single-patient case reports and one study was a small case series. All patients were adults. The mean age of patients was 48.3 ± 12.1 years. In primary syphilis, increased fluorodeoxyglucose (FDG) accumulation could be seen at the site of inoculation or in the regional lymph nodes. In secondary syphilis with lung, bone, gastrointestinal involvement, or generalized lymphadenopathy, increased FDG uptake was the most commonly detected changes. In tertiary syphilis, increased glucose metabolic activity, hypometabolic lesions, or normal glucose uptake might be seen on PET. There were five types of PET scans in neurosyphilis. A repeated PET scan after treatment revealed apparent or complete resolution of the asymmetry of radiotracer uptake. Conclusion: PET is helpful in targeting diagnostic interventions, characterizing disease extent, assessing nodal involvement, and treatment efficacy for syphilis.
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Affiliation(s)
- Jian-Hua Chen
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xin Zheng
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xiu-Qin Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
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9
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Secondary pulmonary syphilis: Case report and review of literature. Ann Dermatol Venereol 2018; 145:278-287. [PMID: 29463465 DOI: 10.1016/j.annder.2017.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/17/2017] [Accepted: 11/02/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Syphilis is a sexually transmitted disease that can affect numerous organs in its secondary or tertiary stages. We describe a case of secondary syphilis with pulmonary involvement and we present a literature review. PATIENTS AND METHODS A 69-year-old male patient was admitted to hospital for dyspnoea and extended papular exanthema with palmoplantar involvement. The serological test for syphilis was positive. Ocular examination showed bilateral papillitis and retinal haemorrhage. Chest radiography revealed an interstitial alveolar infiltrate predominantly in the upper lobes, mild pleural effusion and hilar adenopathy. These infiltrates were slightly hypermetabolic on PET scan suggesting inflammatory or infectious origin. Treatment with intravenous penicillin G was effective on cutaneous, ocular and pulmonary manifestations. DISCUSSION Lung involvement in secondary syphilis is poorly known and rarely described. We found 27 cases of pulmonary syphilis reported in English and the main European languages since 1967. Mean age at diagnosis was 46 years with clear male predominance (89%). HIV co-infection was declared in 5 cases. Treponema pallidum was found in 6 patients using PCR on bronchoalveolar lavage (BAL) (3 patients) or on a lung biopsy (1 patient), immunohistochemistry (IHC) on BAL (1 patient) and Giemsa staining on a pleural fluid sample (1 patient). Chest X-rays may show unilateral or bilateral infiltrates or nodules with or without pleural effusion or hilar adenopathy. Sub-pleural involvement is frequent and penicillin is the treatment of choice. CONCLUSION Pulmonary syphilitic involvement should be suspected where pulmonary symptoms or radiological changes occur in secondary syphilis. IHC, special staining or PCR on BAL, pleural fluid or lung tissue are useful for the identification of spirochetes.
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10
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Ohta A, Furusyo N, Kishihara Y, Eiraku K, Murata M, Kainuma M, Toyoda K, Ogawa E, Hayashi T, Koga T. Secondary Syphilis with Pulmonary Involvement. Intern Med 2018; 57:121-126. [PMID: 29021433 PMCID: PMC5799069 DOI: 10.2169/internalmedicine.8439-16] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 39-year-old Japanese man presented to our hospital complaining of left chest pain and rash on the hands and feet. Plain thoracic computed tomography (CT) revealed multiple nodular shadows in the left lower lobe of the lung. A diagnosis of secondary syphilis was made based on the appearance of the rash and positive serologic tests for syphilis. The patient was started on amoxicillin but was switched to minocycline due to amoxicillin-induced rash on both forearms. Thoracic CT after five months of treatment revealed that the multiple lung nodular shadows had contracted, and secondary syphilis with pulmonary involvement was diagnosed.
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Affiliation(s)
- Azusa Ohta
- Department of General Internal Medicine, Kyushu Central Hospital, Japan
- Department of General Internal Medicine, Kyushu Medical Center, National Hospital Organization, Japan
| | - Norihiro Furusyo
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | - Yasuhiro Kishihara
- Department of General Internal Medicine, Kyushu Medical Center, National Hospital Organization, Japan
| | - Kunimitsu Eiraku
- Department of General Internal Medicine, Kyushu Medical Center, National Hospital Organization, Japan
| | - Masayuki Murata
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | - Mosaburo Kainuma
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | - Kazuhiro Toyoda
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | - Eiichi Ogawa
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | - Takeo Hayashi
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | - Tsunehisa Koga
- Department of General Internal Medicine, Kyushu Central Hospital, Japan
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11
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Joseph Davey D, Kojima N, Konda KA, Gupta P, Leon SR, Calvo GM, Caceres CF, Klausner JD. Transient aortitis documented by positron emission tomography in a case series of men and transgender women infected with syphilis. Sex Transm Infect 2017; 93:551-555. [PMID: 28866636 DOI: 10.1136/sextrans-2017-053140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/02/2017] [Accepted: 05/06/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Syphilis infection persists globally contributing to preventable and treatable morbidity and mortality. How extensive early syphilis disseminates is unknown. To better understand the relationship between early syphilis infection and inflammation over time, our study enrolled six individuals recently infected with syphilis for sequential positron emission tomography (PET) scans. METHODS We evaluated a case series of six individuals with high syphilis titres (two secondary, two early latent and two latent, unknown duration, but with high titre) who received sequential PET scans to assess inflammation over time and its response to treatment. RESULTS At time of PET scan, four of the six individuals were co-infected with HIV. One of the four was not on antiretroviral therapy and three of the four were not virally suppressed (viral load of >400 copies/mL). Baseline rapid plasma reagin (RPR) titres ranged from 1:64 to 1:256 (four of the six participants had prior non-reactive RPR results). Five of the six participants had mild to intense hypermetabolic PET scan activity consistent with cervical (n=5), axillary (n=4), inguinal (n=5) and retroperitoneal (n=1) adenopathy. Mild hypermetabolic activity in the thoracic aortic wall, suggesting aortitis, was present among the same five participants and resolved within 30 days for four of the five participants and 60 days for the other participant. However, widespread lymphadenopathy remained present in PET scans up to 3 months following treatment in two participants. We did not find any abnormal PET scan activity of the central nervous system. CONCLUSION We found abnormal aortic wall PET scan activity suggesting aortitis to be common in a case series of patients with early syphilis. In research settings, PET scans may be a sensitive tool to monitor inflammation associated with syphilis.
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Affiliation(s)
- Dvora Joseph Davey
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.,Division of Infectious Disease, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Noah Kojima
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kelika A Konda
- David Geffen School of Medicine, University of California, Los Angeles, California, USA.,Unit of Health, Sexuality and Human Development, Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Pawan Gupta
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Segundo R Leon
- Unit of Health, Sexuality and Human Development, Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gino M Calvo
- Unit of Health, Sexuality and Human Development, Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos F Caceres
- Unit of Health, Sexuality and Human Development, Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.,Division of Infectious Disease, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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12
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Ogawa Y, Imai Y, Yoshihara S, Fujikura H, Hirai N, Sato M, Ogawa T, Uno K, Kasahara K, Yano H, Mikasa K. Pulmonary involvement of secondary syphilis. Int J STD AIDS 2017; 29:89-91. [PMID: 28661232 DOI: 10.1177/0956462417717653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pulmonary involvement in secondary syphilis is considered a rare occurrence; however, the number of cases has increased in the 2000s. This is likely due to the increased use of computed tomography scans and molecular diagnostic testing. We report a case of an HIV-positive man with pleural chest pain and bilateral subpleural nodules on chest computed tomography. His rapid plasma reagin and Treponema pallidum hemagglutination tests were positive, and the specimen of one of the pulmonary nodules obtained by transthoracic biopsy was positive for the polA gene of Treponema pallidum. Since clinical manifestations of syphilis are highly variable, clinicians should bear in mind that pleural chest pain with bilateral subpleural nodules can be caused by pulmonary syphilis.
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Affiliation(s)
- Yoshihiko Ogawa
- 1 Center for Infectious Diseases, Nara Medical University, Nara, Japan
| | - Yuichiro Imai
- 1 Center for Infectious Diseases, Nara Medical University, Nara, Japan
| | - Shingo Yoshihara
- 1 Center for Infectious Diseases, Nara Medical University, Nara, Japan
| | - Hiroyuki Fujikura
- 1 Center for Infectious Diseases, Nara Medical University, Nara, Japan
| | - Nobuyasu Hirai
- 1 Center for Infectious Diseases, Nara Medical University, Nara, Japan
| | - Masatoshi Sato
- 2 Division of Infectious Diseases, Nara City Hospital, Nara, Japan
| | - Taku Ogawa
- 1 Center for Infectious Diseases, Nara Medical University, Nara, Japan
| | - Kenji Uno
- 3 Division of Infectious Diseases, Minami Nara General Medical Center, Nara, Japan
| | - Kei Kasahara
- 1 Center for Infectious Diseases, Nara Medical University, Nara, Japan
| | - Hisakazu Yano
- 4 Department of Microbiology and Infectious Diseases, Nara Medical University, Nara, Japan
| | - Keiichi Mikasa
- 1 Center for Infectious Diseases, Nara Medical University, Nara, Japan
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13
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Cerchione C, Maraolo AE, Marano L, Pugliese N, Nappi D, Tosone G, Cimmino I, Cozzolino I, Martinelli V, Pane F, Picardi M. Secondary syphilis mimicking malignancy: A case report and review of literature. J Infect Chemother 2017; 23:576-578. [PMID: 28456488 DOI: 10.1016/j.jiac.2017.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/27/2017] [Accepted: 03/08/2017] [Indexed: 11/30/2022]
Abstract
A 56-year-old man developed disseminate lymphadenopathies, associated with hepato-splenomegaly, fever, nocturnal sweating and weight loss. Imaging studies in particular FDG-PET/CT raised the suspicion of a malignant disease. But blood flow cytometry assay for B/T cell clonality was negative and fine-needle biopsy of enlarged laterocervical lymph node showed a not specific "reactive hyperplasia". Four months later, the patient developed a non-itching rash; since a further anamnestic investigation revealed an history of high-risk sexual intercourse, the patient underwent serological tests for Treponema pallidum that were positive at high titer, after a first negative screening. Made the diagnosis of secondary syphilis, the patient responded to the treatment with benzyl penicillin with complete resolution of symptoms. This case highlights the importance of carefully screening the patients with suspected lymphoadenopathies also for lue, particularly in presence of behavioral risk factors.
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Affiliation(s)
- Claudio Cerchione
- Department of Clinical Medicine and Surgery - Hematology, University of Naples "Federico II", Italy.
| | - Alberto Enrico Maraolo
- Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples "Federico II", Italy
| | - Luana Marano
- Department of Clinical Medicine and Surgery - Hematology, University of Naples "Federico II", Italy
| | - Novella Pugliese
- Department of Clinical Medicine and Surgery - Hematology, University of Naples "Federico II", Italy
| | - Davide Nappi
- Department of Clinical Medicine and Surgery - Hematology, University of Naples "Federico II", Italy
| | - Grazia Tosone
- Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples "Federico II", Italy
| | - Ilaria Cimmino
- Department of Translational Medical Sciences, University of Naples "Federico II", Italy
| | - Imma Cozzolino
- Department of Translational Medical Sciences, University of Naples "Federico II", Italy
| | - Vincenzo Martinelli
- Department of Clinical Medicine and Surgery - Hematology, University of Naples "Federico II", Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery - Hematology, University of Naples "Federico II", Italy
| | - Marco Picardi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Italy
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Ripoll E, Montironi C, Alós L, Pujol T, Berenguer J, Oleaga L. Oropharyngeal Syphilis: Imaging and Pathologic Findings in Two Patients. Head Neck Pathol 2016; 11:399-403. [PMID: 27699642 PMCID: PMC5550383 DOI: 10.1007/s12105-016-0758-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/23/2016] [Indexed: 12/29/2022]
Abstract
Syphilis is a widespread infection with increasing frequency in developed countries, especially among men who have sex with men. We present two cases of oropharyngeal syphilis in two middle-aged men who presented with a painless tonsillar ulcer and progressive enlargement of cervical lymph nodes suspected of being a tonsillar tumour. A pathologic analysis of the ulcer led to an accurate diagnosis. We review the imaging and pathologic findings to emphasize the importance of taking syphilis into account in the differential diagnosis.
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Affiliation(s)
- Enric Ripoll
- Radiology Department, Hospital Clínic de Barcelona, Villarroel 170, Barcelona, Spain
| | - Carla Montironi
- Pathology Department, Hospital Clínic de Barcelona, Villarroel 170, Barcelona, Spain
| | - Llucia Alós
- Pathology Department, Hospital Clínic de Barcelona, Villarroel 170, Barcelona, Spain
| | - Teresa Pujol
- Radiology Department, Hospital Clínic de Barcelona, Villarroel 170, Barcelona, Spain
| | - Joan Berenguer
- Radiology Department, Hospital Clínic de Barcelona, Villarroel 170, Barcelona, Spain
| | - Laura Oleaga
- Radiology Department, Hospital Clínic de Barcelona, Villarroel 170, Barcelona, Spain
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15
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Riganti J, Martin M, Torre A, Scalia G, Clara L, Vallone M, Galimberti R. Secondary syphilis with pulmonary involvement. J Eur Acad Dermatol Venereol 2015; 30:e177-e179. [DOI: 10.1111/jdv.13483] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J. Riganti
- Department of Dermatology; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | - M. Martin
- Department of Dermatology; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | - A.C. Torre
- Department of Dermatology; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | - G. Scalia
- Department of Dermatology; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | - L. Clara
- Department of Infectology; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | - M. Vallone
- Department of Internal Medicine; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | - R.L. Galimberti
- Department of Dermatology; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
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