Gastric Syphilis Presenting as a Nodal Inflammatory Pseudotumor Mimicking a Neoplasm: Don’t Forget the Treponema! Case Report and Scoping Review of the Literature of the Last 65 Years

Abstract

Despite the fact that gastric syphilis is considered rare, it is reported as a type of organic involvement that is present in a large proportion of secondary syphilis cases, even though gastritis presenting with symptoms is extremely rare. Clinical, radiological, and endoscopic findings are non-specific and frequently mimic the symptoms of gastric adenocarcinoma or lymphoma, making diagnosis difficult. Immunostaining is required for this diagnosis. We would like to emphasize the importance of being suspicious of GS when a gastric mass exhibits the histologic features of an inflammatory pseudotumor (IPT), as previously reported for nodal IPT caused by luetic infection. We described a 56-year-old man who presented to the oncology department with a 3-month history of anorexia, epigastric pain, nausea, vomiting, and weight loss, as well as an initial radiological and endoscopic suspicion of gastric adenocarcinoma, in which immune staining allowed us to diagnose GS. In addition, we conducted an updated scoping review of the scientific literature to show the clinical, laboratory, and therapeutic findings in GS patients over the last 65 years.

Beyond Tumors: Gastric Syphilis Emulating a Gastric Neoplasia

“…One aspect to consider is the variety of symptoms that may present in patients with gastric syphilis. The main symptoms include vomiting, epigastric pain, weight loss, early satiety, and anorexia [2][3][4][6][7][8]. These described symptoms are nonspecific, so without clinical suspicion, finding gastric syphilis in an endoscopic procedure is rare and unexpected [4].…”

“…Initially, it involves the development of an ulcerated lesion in the affected area, followed by systemic involvement, and eventually, a final phase characterized by organic damage, typically occurring many years after the primary infection. Gastric involvement is rare, accounting for only 1% of presentations, predominantly in the secondary stage, and can mimic other diseases, such as gastric cancer, lymphomas, or nodal inflammatory pseudotumors, which are serious diseases requiring early treatment [2,3].…”