A case of secondary syphilis presenting as multiple pulmonary nodules

Abstract

Syphilis is a sexually transmitted disease caused by Treponema pallidum. The prevalence of this disease has recently increased worldwide. However, pulmonary involvement in secondary syphilis is extremely rare. A 51-year-old heterosexual male patient presented with multiple pulmonary nodules with reactive serology from the Venereal Disease Research Laboratory test and positive fluorescent treponemal antibody absorption testing. A hematogenous metastatic malignancy was suspected and an excisional lung biopsy was performed. Histopathological examination showed only central necrosis with abscess and plasma cell infiltration, but no malignant cells. The patient reported sexual contact with a prostitute 8 weeks previously and a penile lesion 6 weeks earlier. Physical examination revealed an erythematous papular rash on the trunk. Secondary syphilis with pulmonary nodules was suspected, and benzathine penicillin G, 2.4 million units, was administered. Subsequently, the clinical signs of syphilis improved and the pulmonary nodules resolved. The final diagnosis was secondary syphilis with pulmonary nodular involvement.

Unusual Presentation of Secondary Syphilis in Korea: 2010-2014 Review

“…2 Pulmonary lesions appear as an infiltration, 3 consolidation with pleural effusion, 32 solitary pulmonary nodule, 33 or multiple ill-defined nodules. 34 Kim et al 35 reported the third case of secondary syphilis, presenting as multiple pulmonary nodules, and this was the first report in Korea. The importance of this issue is that well-defined pulmonary nodules could mimic hematogenous metastatic carcinoma.…”

Secondary syphilis with pulmonary involvement mimicking lymphoma: a case report

“…The differential diagnosis for pulmonary involvement in patients with syphilis is extensive and includes primary and metastatic lung cancer, lymphoma, fungal infection, tuberculosis, septic embolism, pulmonary infarction, sarcoidosis, rheumatoid nodules, and vasculitis 2,6 . While microbiological diagnosis of syphilis in these cases is difficult, transbronchial biopsy, open lung biopsy, bronchial lavage, immunohistochemistry, and polymerase chain reaction may reveal the presence of Treponema pallidum 7 .…”

A skin rash with multiple pulmonary nodules

“…However, pulmonary involvement in secondary syphilis is extremely rare [2,3]. To our knowledge, only seven cases of secondary syphilis with pulmonary involvement including CT findings have been published in the English-language literature.…”