A Case of Primary Syphilis in the Rectum

Abstract

A 30-yr-old man was referred for suspicious rectal cancer because of ulcerated lesions in the rectum and a palpable mass in left inguinal area. Sigmoidoscopy showed two indurated masses and histologic evaluation of biopsy revealed obliterative endarteritis with heavy plasma cell infiltration. Both venereal disease research laboratories (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS) tests were positive. After injection of penicillin G benzathine for 3 weeks, the rectal chancre and the palpable mass disappeared.

Primary chancre in the rectum: A report of rare case of syphilis

“…There were multiple perirectal lymph node enlargements, as reported by Jae and colleagues [3]. (2) There was lymphadenopathy in the left inguinal region on CT. If the rectal mass was cancer, lymphadenopathy in the left inguinal region suggested metastasis, which meant late stage, but the patient didn't appear obstruction and cachexia.…”

“…oral, and anal sex. Homosexuality is very important for clinical diagnosis in this case, but the patient wouldn't open up to the doctor easily, just like in Korea or certain other countries, where homosexuality still carried a stigma [2,5,6]. Therefore, physician should recognize the CT features and make an effort to get the clinical history.…”

“…However, rectal syphilis is a rare case, especially with primary chancre formation. Most physicians tend to consider rectal mass with ulceration as a neoplasm [2]. In this case, clinical signs, CT and sigmoidoscopy all suggested a rectal neoplasm.…”

Anorectal syphilis mimicking Crohn’s disease

“…It is usually asymptomatic and, less frequently, presents as proctitis, ulceration, and pseudotumors [6,11]. As it is difficult to diagnose, patients usually receive inappropriate treatments [7,12,13]. Primary syphilis can present as an anorectal chancre, which is classically painless.…”

Haemorrhoids, rectal prolapse, anal fissure, peri-anal fistulae and sexually transmitted diseases

“…In Western countries, the incidence of rectal syphilis is rising, especially in active homosexual males [78,79,91,92].…”