Rectal syphilis mimicking rectal cancer

[Syphilis in surgery-Safe diagnosis and correct treatment]

BACKGROUND

The incidence of syphilis has clearly increased in Germany in recent years. This infectious disease has many forms of manifestation and can imitate surgical diseases.

MATERIAL AND METHODS

Comprehensive footage of experiences in a proctological center demonstrates these manifestations and explains the correct management.

RESULTS

The likelihood of confusion of syphilis with anal fissures, anogenital warts, proctitis and rectal cancer is high.

CONCLUSION

Surgeons can encounter syphilis, the "chameleon of medicine" and must know the differential diagnoses.

A Rare Cause of Diarrhea: Intestinal Spirochetosis in an HIV-Positive Patient

Intestinal spirochetosis (IS) is a rare gastrointestinal infection with vague presenting symptoms. Diagnosis is confirmed histopathologically. Risk factors include homosexuality and HIV. Antibiotic treatment with metronidazole usually leads to resolution of symptoms. We present the case of a 56-year-old HIV-positive man with chronic, watery diarrhea who was diagnosed with IS. This case highlights the importance of considering IS in the differential in HIV-positive patients with nonspecific gastrointestinal symptoms after more common etiologies have been ruled out.

Syphilitic proctitis presenting as locally advanced rectal cancer: A case report

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.

Rectal cancer mimic: a rare case of syphilitic proctitis

Syphilitic proctitis is a rare presentation of sexually transmitted infection that poses a diagnostic challenge as it mimics rectal cancer clinically, radiologically and endoscopically. We report a case of a 66-year-old male patient with a background of HIV infection presenting with obstructive bowel symptoms and initial diagnosis of rectal cancer on CT. Sigmoidoscopy and histopathology were non-diagnostic. A diagnosis of secondary syphilis was suspected after obtaining sexual history and diagnostic serology, avoiding planned surgical intervention.

Extracavitary primary effusion lymphoma recurring with syphilis in an HIV-infected patient

A 59-year-old Caucasian man infected with HIV, in remission from human herpes virus-8-positive extracavitary primary effusion lymphoma (EC-PEL), presented to a sexual health clinic with fever and rectal pain 10 weeks after a single episode of receptive anal sexual intercourse with another man. He was initially treated for a presumptive diagnosis of lymphogranuloma venereum proctitis, then for syphilis on positive serology. Rectosigmoidoscopy revealed a single ulcerated rectal mass; endoscopic biopsies confirmed the recurrence of EC-PEL. The patient received chemotherapy and went into remission. This is the first reported case of EC-PEL occurring synchronously with early syphilis, and specifically at the site of inoculation, which can be a major diagnostic challenge since both conditions may present with lymphadenopathy, mucosal involvement and constitutional symptoms. We reviewed the literature for similar cases and hypothesised that syphilis may have triggered the recurrence of this rare lymphoma.

Rectal syphilitic ulcer

Shyphilis is a chronic infectious disease caused by Treponema Pallidum bacteria. Syphilis is most commonly spread through sexual activity, by direct contact with the inoculation point of the spirochete. It has been demonstrated that the desease is more prevalent in men who have sex with men. In primary syphilis, the chancre appears 2-3 weeks after the initial exposure mostly in genitals, but also in oral cavity, pharynx or anus. Secondary syphilis is a systemic disease. It occurs weeks or months later in about 25% of people with primary syphilis that has not been treated. Although many people who present with secondary syphilis do not report previosly having had the classic chancre of primary syphilis.

[A Case of Rectal Syphilis Incidentally Found at Regular Medical Check-up]

Syphilis is a rare disease in the rectum. It is difficult to diagnose because the characteristics of the rectal syphilis rectal lesion are highly varied. The endoscopic findings of rectal syphilis are proctitis, ulcers, and masses. If rectal syphilis is suspected to be the cause for rectal lesions, it is important for physicians to consider the sexual history and sexual orientation of the patient. We report a case of incidental rectal syphilis in a 41-year-old man diagnosed during a regular medical check-up.

Imaging of acute anorectal conditions with CT and MRI

Anorectal disorders are a common cause of presentation to the emergency department (ED). While the most frequently encountered anorectal conditions, such as hemorrhoids and anal fissures, are relatively benign and do not require imaging for diagnosis or management, there are multiple potentially life threatening anorectal conditions for which imaging is an important component of evaluation, diagnosis, and management. Although computed tomography (CT) is the most commonly used imaging modality for evaluation of anorectal pathology in the ED, magnetic resonance imaging (MRI) has an increasingly important role in the detection, characterization and management of specific anorectal conditions. This pictorial essay will review the imaging anatomy of the anorectum, summarize imaging protocols, and discuss the clinical presentation, imaging appearance, and differential diagnosis of anorectal conditions that may present to the emergency department, including infectious, inflammatory, malignant and vascular conditions.

The Great Pretender: Rectal Syphilis Mimic a Cancer

Rectal syphilis is a rare expression of the widely recognised sexual transmitted disease, also known as the great imitator for its peculiarity of being confused with mild anorectal diseases because of its vague symptoms or believed rectal malignancy, with the concrete risk of overtreatment. We present the case of a male patient with primary rectal syphilis, firstly diagnosed as rectal cancer; the medical, radiological, and endoscopic features are discussed below.

Syphilis? An Unusual Cause of Surgical Emergency in a Human Immunodeficiency Virus-Infected Man

We report on a human immunodeficiency virus-infected man undergoing urgent anorectal surgery, with multi-centimeter fungating masses discovered inside the anus. Initial pathology was inconclusive. After the patient developed a disseminated rash postoperatively determined to be secondary syphilis, the anorectal pathology was reviewed and Treponema pallidum DNA was amplified by polymerase chain reaction from the mass.

Sexually transmitted proctitis

There are many different sexually transmitted infections that can cause proctitis. Recognition of the common symptoms with anoscopic examination is crucial in accurate diagnosis of the pathogen. Clinicians should have a high index of suspicion of more than one inciting pathogen. Treatment should be prompt and extended to sexual partners who have been exposed to the disease. Effective treatment can alleviate the discomfort and potentially serious complications associated with sexually transmitted proctitides. This article illustrates and discusses the clinical presentations, diagnostic pearls, and treatments of sexually transmitted proctitides.

Anorectal opportunistic diseases in human immunodeficiency virus/acquired immunodeficiency syndrome patients: spectrum of cross-sectional imaging findings

Patients infected with the human immunodeficiency virus, particularly male homosexuals, are prone to develop disorders involving the anorectal and perineal structures. Cross-sectional imaging techniques, such as multidetector computed tomography with multiplanar reformations and magnetic resonance imaging performed with phased-array coils, are increasingly adopted to detect and stage infectious and neoplastic diseases, and to assess posttreatment modifications. Pyogenic perianal sepsis may be usefully investigated with imaging, particularly to assess the presence and topography of abscess collections to allow a correct surgical choice. Rectal inflammatory involvement is frequently detected during intestinal opportunistic infections, such as cytomegalovirus, pseudomembranous, and amebic colitides, including primary and secondary imaging signs consistent with proctocolitis. Anal carcinoma and intestinal lymphoma are increasingly diagnosed; therefore, special attention should be paid to the identification of solid tissue consistent with tumor; furthermore, MRI provides optimal staging and posttreatment follow-up of neoplastic lesions. Knowledge of this varied spectrum of anorectal and perineal opportunistic abnormalities and their imaging appearances should help radiologists to propose appropriate differential diagnoses, suggest correlation with laboratory and microbiological assays or biopsy, and reliably assess therapeutic response.

Anorectal syphilis mimicking Crohn's disease

Anorectal syphilis, one of the great masqueraders in medicine, can be difficult to diagnose not only because of its variable symptoms but also because it is hard to think of unless a detailed history about sexual preferences and practices, including homosexuality, has been gathered. With increasing acceptance of sexual activity in our culture, despite moral and religious issues, various forms of sex have led to many different clinical conditions of sexually transmitted diseases. In this report, we describe a rare case of primary anorectal syphilis with clinical, endoscopic and histologic features that was misdiagnosed as Crohn's disease.