Unusual presentations and pitfalls of secondary syphilis: osteitis, pneumonia and malignancy

Abstract

SUMMARYSyphilis can show unexpected clinical characteristics rendering its diagnosis difficult. We report on two cases of secondary syphilis presenting with atypical histories of knee or cervical pain and cough. Both had bone involvement and one, pulmonary involvement, documented by MRI, CT scan and PCR. Both responded well to therapy with intravenous aqueous penicillin G followed by intramuscular benzathine penicillin G, but a pulmonary adenocarcinoma was diagnosed during follow-up in one case. BACKGROUND

Syphilis the great pretender: when is cancer not cancer?

“…Lung involvement in secondary syphilis was thought to be rare but modern diagnostics such as CT have recently led to a significant increase in reports of secondary pulmonary syphilis 5. In one case series, 60% had symptoms of chest pain.…”

Primary lung carcinoma combined with pulmonary amyloidosis secondary to syphilis infection

“…Pulmonary syphilis is rare and there are only 14 cases were reported in the English language literature (7). Radiological presentation included infiltrates and solitary or multiple nodules, sometimes associated with pleural effusion and mimicking malignant lesions (8). Diagnosis of osseous or pulmonary syphilis in reported cases was most often made based on radiological images resolving on penicillin in the context of positive serology.…”

Pulmonary involvement of secondary syphilis

“…A literature review by David et al 2 in 2006 reported only nine cases of pulmonary syphilis in 37 years ; however, 12 cases were reported in the subsequent eight years. [2][3][4][5][6][7][8][9][10][11][12][13][14] Although a worldwide increase in syphilis incidence was reported in the 2000s, it is still lower than the incidence observed from the 1970s to the 1990s; therefore, the increasing number of cases of pulmonary syphilis is likely not due to the relatively higher syphilis incidence reported recently.…”

“…Interestingly, multiple subpleural nodules were found in all of chest CT scans. [2][3][4][5][6][7][8][9][10][11][12][13][14] reported that no specific lesion could be identified in their literature review. However, recent case reports reveal that multiple subpleural nodules (typically located in the lower lobes) are considered one of the prominent features of pulmonary syphilis.…”

“…2,[7][8][9][10][11][12] In the four published cases of pulmonary syphilis (including ours), PCR or immunohistochemistry of respiratory samples tested positive for syphilis. 2,3,14 Buffet et al 15 suggested that both PCR and immunohistochemistry are reliable diagnostic tools for syphilis with comparably high levels of sensitivity and specificity.…”