Gummatous Syphilis Research Articles

Gummatous Syphilis: A Rare Entity Mimicking Carcinoma Penis

ObjectiveTo describe a rare case of gummatous syphilis of the penis with urethrocutaneous fistula mimicking penile carcinoma causing a diagnostic dilemma. MethodA 54 year old man presented with an ulcerative lesion on glans penis. Patient was managed with partial penectomy in view of erosive growth giving rise to urethrocutaneous fistula. ResultsHistopathology showed granulation tissue, necrotizing vasculitis and epithelioid cell granuloma. Immunohistochemistry stained positive for Treponema and patient was treated accordingly. ConclusionSyphilis is rarely encountered in daily clinical practice in the penicillin era. Despite a negative serology and the clinical picture highly suggestive of malignancy, the histopathology helped in clinching the rare diagnosis.

Retrospective review of tertiary and neurosyphilis cases in Alberta, 1973–2017

ObjectivesTo review the notification rate and characteristics of tertiary and neurosyphilis cases in Alberta, Canada in the postantibiotic era.MethodsA retrospective review of all neurosyphilis and tertiary syphilis cases reported in...

Autopsy case of acute pulmonary thromboembolism with neurosyphilis

BackgroundSyphilis is caused by the bacterium Treponema pallidum. Syphilis is a multistage disease, and the clinical stages of syphilis are divided to primary, secondary, and tertiary syphilis, where the tertiary stage is classified as neurosyphilis, cardiovascular syphilis, or gummatous syphilis. Here, we describe an autopsy case of acute pulmonary thromboembolism with neurosyphilis.Case presentationA male in his early 40s began to complain of hallucinations. He was admitted to a psychiatric hospital as an emergency case 4 days before death. He was physically restrained to control agitation and aggressiveness. The patient was severely obese (BMI 36.45). At autopsy, large thromboembolic masses filled the pulmonary trunk and both pulmonary arteries. Thrombi were also noted in the right popliteal vein and bilateral gastrocnemius and soleus veins, suggesting bilateral lower extremity deep vein thrombosis. Dissection of the brain, which weighed 1457 g, revealed no noteworthy macroscopic findings. Histological examination showed lymphocyte infiltration into the perivascular space of the brain tissue with no vasculitis. Immunohistochemical staining of T. pallidum was negative, the fluorescent treponemal antibody-absorption test was positive, the rapid plasma reagin titer was 1:4, and the T. pallidum hemagglutination assay titer was 1:10,240. Real-time PCR assay of the brain tissue detected low copy numbers of T. pallidum genes. Altogether, the cause of death was acute pulmonary thromboembolism resulting from bilateral lower extremity deep vein thrombosis. The patient also had early-stage meningovascular neurosyphilis.ConclusionAn autopsy case of acute pulmonary thromboembolism with meningovascular neurosyphilis is presented, including histopathological examination, serological assessment, and genetic testing. Forensic pathologists should pay attention to a myriad of syphilitic manifestations. The contributing factors for thrombosis in the present case included severe obesity, probable dehydration, and physical restraints implemented to control meningovascular neurosyphilis-induced neuropsychiatric symptoms.

Imaging findings of gummatous syphilis of the pancreas: a case report

Imaging findings of gummatous syphilis of the pancreas: a case report

A case of tertiary syphilis manifested with multiple skin gummas

The tertiary cutaneous syphilis has become extremely rare as a result of the effective treatment of early syphilis with penicillin and occasional antibiotic therapy for concomitant infections. We report a case of tertiary gummatous syphilis associated with asymptomatic neurosyphilis that was initially misdiagnosed as basal cell carcinoma of the skin. A 67-year-old woman presented with the 18-month history of multiple, firm, bluish-red asymptomatic nodes on the parietal scalp, chin and lateral part of the trunk that had developed without preceding trauma. One node on the trunk had small central ulceration covered with dry yellowish crust. On the left retroauricular area the brownish-purple atrophic scar was observed. Blood tests revealed reactive VDRL, ELISA and TPHA assays. Skin biopsy has showed endarteritis with endothelial swelling and caseating granulomas along with plasmocytic infiltrate in the dermis and subcutaneous tissue. Increased lymphocyte count and the positive VDRL test with cerebrospinal fluid have confirmed the diagnosis of asymptomatic syphilitic meningitis in this patient. The treatment with aqueous penicillin intravenously has lead to resolution of the skin infiltrates and progressive more than 4-fold reduction of follow-up serum VDRL titers. This case is reported as a reminder of the possibility of tertiary syphilis with misleading clinical patterns in patients infected during the epidemics of 1995-2000. We would like to emphasize the necessity to perform timely serological and pathomorphological study to prevent misdiagnosis and mistreatment.

Disseminated congenital syphilis: a case report

A 66-hour-old male neonate presented with generalized slight skin xanthochromia and scattered erythematous skin eruptions that faded with pressure. Serological testing revealed a positive Treponema pallidum agglutination (TPPA) test and positive anti-Treponema pallidum IgM antibodies. The patient was diagnosed as congenital syphilis. Neither the results of lumbar puncture and cerebrospinal fluid analysis nor those of X-ray examination of limb long bones supported the diagnosis of neurosyphilis or osseous syphilis. The patient presented with bloody stools and recurrent fever after regular treatment with aqueous penicillin for 14 days. Changes of antibiotics resulted in no improvement. Finally, the patient died of disseminated intravascular coagulation (DIC) and multi-organ functional impairment. Autopsy examination revealed inflammatory pathological changes caused by syphilitic infection in multiple organs and tissues, with gumma (gummatous syphilis) and polyangitis as the main pathological changes. Treponema pallidum was detected in liver and lung tissues by silver staining. His mother was found to be positive for anti-Treponema pallidum antibodies in the fourth month of pregnancy, but received no regular treatment with penicillin. Key words: Syphilis, congenital; Newborn; Penicillins; Autopsy

ONE NIGHT WITH VENUS, A LIFETIME WITH MARS

I present a case of neurosyphilis presenting as acute stroke in a 44-year-old male; I review the current literature, with a particular emphasis on diagnostics and the pitfalls of serological testing. Neurosyphilis is an imprecise term and subsumes meningitic, meningovascular, parenchymatous and gummatous syphilis. Of these, meningovascular syphilis is most commonly associated with large vessel arteritis and stroke, particularly of the middle cerebral artery. Although syphilis rates have increased since the latter part of the 20th century, neurosyphilis remains a rare disease and epidemiological estimates are marred by imprecise use of terminology and the complexity of interpreting common laboratory tests. Neurosyphilis can present in myriad ways depending on the extent of meningeal and vascular involvement, earning it the moniker–‘the great imitator’. There are no characteristic imaging features; radiologically, syphilitic arteritis most frequently involves the middle cerebral artery, but may include any intracranial vessels. Testing uses highly sensitive, but non-specific treponemal tests, followed by highly specific, but insensitive non-treponemal tests. Investigation must be thoughtful if improper use and interpretation is to be avoided. The rising incidence of syphilis in recent decades warrants it9s consideration in the differential diagnosis of atypical stroke, particularly as early treat-ment with penicillin is effective.

Syphilitic Gummas Mistaken for Liver Metastases

occurs years after the initial infection, and is characterized by a chronic inflammatory response to the organism in sanctuary sites. Gummatous syphilis is a type of tertiary syphilis caused by a delayed hypersensitivity reaction to the Treponema pallidum organism. 3 A gumma is a granuloma, histologically characterized by a central area of necrosis surrounded by mononuclear, epithelioid, and giant cells, and ranging in size from microscopic to several centimeters. 3 Spirochetes only rarely are identified in pathologic specimens, and diagnosis instead relies on serologic testing as well as therapeutic response. The incidence of hepatic involvement ranges from 0.9% to 16% in autopsy studies. 4 Gummas may be visible on CT imaging as low-attenuation lesions with slight peripheral enhancement and rare calcifications, which is an appearance that may be confused with metastatic cancer or an abscess. 5 Treatment for gummatous syphilis without neurosyphilis consists of intramuscular penicillin G for 3 weeks; if neurosyphilis is present, as in our patient, administration of intravenous penicillin may be necessary. 6

La syphilis au CHU de Nantes entre 2000 et 2010 : à propos de 36 patients hospitalisés

PurposeSyphilis infection increase has been observed since the early 2000s. The medical records of patients hospitalized for syphilis at the tertiary care hospital of Nantes between 2000 and 2010 were retrospectively reviewed. MethodsCases were selected on the basis of serological database of the laboratory of bacteriology and extraction from the PMIS. Syphilis cases were defined by both positive TPHA and VDRL tests. ResultsThe number of positive serology testing was increased eightfold within ten years. Among the 36 patients with syphilis hospitalized cases, 97% were male, aged 17 to 75 years. Eighteen were HIV-infected patients. Among them, 94% were homosexuals and 67% had a history of sexually transmitted infections. The mean time between symptoms and diagnosis was significantly higher in non HIV-infected patients. Clinical forms of syphilis were cutaneomucous secondary syphilis with frequent systemic symptoms for 33%, neurosyphilis, including frequent uveitis for 50%, and gummatous tertiary syphilis involving bones for one patient. Secondary syphilis cases were treated with one to three doses of benzathine penicillin G. Late syphilis and cases of neurosyphilis were treated with penicillin G or ceftriaxone. Neurosensory sequelae accounted for 39% neurosyphilis cases. ConclusionThis study highlights the incidence increase of syphilis cases in France, frequent poor prognosis of neurosyphilis cases, and diagnosis difficulties, particularly in non HIV-infected patients. This emphasizes the broader use of syphilis serology for compatible medical situations.

Gummatous Syphilis of the Adrenal Gland

A 55-year-old man with no relevant history was analyzed for weight loss, night sweats, and left upper quadrant pain. An abdominal ultrasound and CT scan were performed, revealing a lobulated rim-enhancing mass in the left adrenal gland. Further analysis by an F-FDG PET/CT scan demonstrated high uptake in the periphery of the adrenal lesion with central photopenia. Because a primary malignancy was suspected, an adrenalectomy was performed. Histopathology, however, revealed a necrotizing granulomatous infection. Serum was tested positive for syphilis and Treponema pallidum infection. Results of additional HIV tests were negative. The adrenal tumor proved to be an expression of gummatous syphilis.

Peliosis and gummatous syphilis of the liver: A case report

Peliosis hepatis is a rare benign vascular disorder of the liver that may be associated with malignancy, infection and drugs. The imaging manifestation of this disorder is often variable and nonspecific making its diagnosis difficult. We describe a rare case of peliosis hepatis and gummatous syphilis of the liver with emphasis on CT findings. Image characteristics of our patient included pseudotumoral appearance of peliosis hepatis, isodensity to the adjacent liver parenchyma on unenhanced and dual-phase scanning. To our knowledge, peliosis hepatis associated with syphilis and unique enhancement pattern has not been reported. Considering the imaging features of peliosis hepatis, it should be considered in the differential diagnosis of atypical focal hepatic lesion.

An unusual presentation of oral syphilis

A case of late, non-infectious, gummatous syphilis presenting with intra-oral arterial haemorrhage in an 81 year-old lady is described.

TREATMENT OF GUMMATOUS HEPATIC SYPHILIS WITH PENICILLIN

THIS is the first report dealing with penicillin as used in the treatment of gummatous hepatic syphilis. Two cases are presented. REPORT OF CASES Case 1. —A 49 year old Negro housewife was admitted to the hospital on Oct. 25, 1943, because of right-sided abdominal and thoracic discomfort of four years' duration and soreness of the right knee of two years' duration. The past and family histories were not pertinent except that a blood serologic test for syphilis had been negative in 1929. The patient said that she had contracted no venereal diseases. For four years she had had attacks of pleurisy on the right side, which had at times required medical care. One and a half years before admission she began to be troubled with pain and tightness in the right upper quadrant of the abdomen, together with a feeling of fulness in the region of the liver.