Primary syphilis presenting as a painful unilateral inguinal lymphadenopathy, without cutaneous manifestations, in a 71-year-old Japanese man: A case report

Yorita, Kenji; Ito, Chikane; Fujioka, Ai; Kashiwagi, Keisuke; Yamai, Hiromichi; Nakatani, Kimiko; Kumon, Tatsuya

doi:10.1016/j.radcr.2022.10.045

Cited by 2 publications

(2 citation statements)

References 6 publications

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“…However, these tests are routinely unavailable, requiring special equipment and considerable experience and expertise to interpret the results. Warthin‐Starry silver staining and immunocytochemical and immunohistochemical study using anti‐ T. pallidum antibodies are useful and routinely available 4,5,13 . However, the sensitivity for detecting the organisms by Warthin‐Starry silver staining was shown to be lower than that of immunohistochemistry 14 .…”

Section: Discussionmentioning

confidence: 99%

“…Warthin-Starry silver staining and immunocytochemical and immunohistochemical study using anti-T. pallidum antibodies are useful and routinely available. 4,5,13 However, the sensitivity for detecting the organisms by Warthin-Starry silver staining was shown to be lower than that of immunohistochemistry. 14 Polymerase chain reaction testing to detect T. pallidum DNA is also useful but routinely unavailable as there are no commercially available test kits.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic utility of fine‐needle aspiration cytology in syphilitic lymphadenitis: A case report

Yorita

Ohara

Tahara

et al. 2023

Diagnostic Cytopathology

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Syphilis is a sexually transmitted infection that causes serious health problems without treatment. Detection of syphilis is necessary to stop the spread of the infection.Cytological screeners and pathologists may experience fine-needle aspiration cytology (FNAC) for syphilitic lymphadenitis; however, its characteristic cytological features are rarely reported. We present FNAC cytological features of syphilitic lymphadenitis in a case of a 21-year-old man. He presented with a sore throat and painful neck lymphadenopathy. His swollen and painful neck persisted even with antibiotic treatment. Necrotizing lymphadenitis and lymphoma were clinically suspected. FNAC was taken from the swollen lymph node. Cytologic findings of the specimen showed various inflammatory cells with small-sized vessels arranged in a branching/arborizing fashion. The vessels were surrounded by inflammatory cells, including plasma cells, neutrophils, and macrophages. Perivascular plasma cell cuffing was focally seen along with inconspicuous granulomas. Neutrophils appeared to involve the vascular wall. The cytological findings suggested syphilitic lymphadenitis, and clinical findings and serological tests confirmed primary syphilis with concomitant human immunodeficiency virus infection. Branching/arborizing vessels associated with many plasma cells, vascular involvement of neutrophils, and granulomas may suggest syphilitic infection if the specimen is obtained via FNAC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnostic utility of fine‐needle aspiration cytology in syphilitic lymphadenitis: A case report

Yorita

Ohara

Tahara

et al. 2023

Diagnostic Cytopathology

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A Case of Syphilis Associated With Genital and Extragenital Hard Chancres, Inguinal Lymphadenitis, and Systemic Symptoms

Mima,

Yamamoto,

Iozumi

2024

Cureus

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Syphilis is a sexually transmitted infection caused by the spirochete Treponema pallidum (TP) subspecies pallidum . Syphilis can be transmitted via contact with infected bodily fluids, such as blood or semen, congenital infection, blood transfusion, or organ transplantation. After a brief incubation period, the disease manifests with signs and symptoms such as genital ulcers, erythematous papules on the palms and soles, fever, and lymphadenopathy. The clinical presentation of syphilis is varied, making its diagnosis challenging. Syphilitic ulcers or erosions (hard chancres) may occur in extragenital regions, and the disease may present as isolated lymphadenopathy without skin lesions. In some cases, lymphadenopathy accompanied by elevated levels of inflammatory markers may mimic hematologic malignancies. Herein, we report a rare case of syphilis associated with genital and extragenital chancres, as well as inguinal lymphadenopathy, in a 31-year-old man. The patient developed a finger ulcer and painless swelling of the left inguinal lymph node, initially suspected to be a skin infection and treated with topical and oral antibiotics, but with poor improvement. During treatment, systemic symptoms such as fever, malaise, joint pain, and loss of appetite emerged, and blood tests showed elevated C-reactive protein and soluble interleukin-2 receptor levels, suggesting suppurative lymphadenitis or hematologic malignancy. Although a lymph node biopsy was considered, a genital ulcer appeared later, raising suspicion of syphilis. TP antibodies were positive, and titers of quantitative rapid plasma reagin and TP antibodies were high, leading to a diagnosis of syphilitic chancres and lymphadenitis. After two months of amoxicillin treatment, the clinical symptoms and blood test results improved. This case highlights the potential time lag in the appearance of chancres in multiple regions and shows that syphilitic lymphadenopathy may mimic hematologic malignancies.

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Primary syphilis presenting as a painful unilateral inguinal lymphadenopathy, without cutaneous manifestations, in a 71-year-old Japanese man: A case report

Cited by 2 publications

References 6 publications

Diagnostic utility of fine‐needle aspiration cytology in syphilitic lymphadenitis: A case report

Diagnostic utility of fine‐needle aspiration cytology in syphilitic lymphadenitis: A case report

A Case of Syphilis Associated With Genital and Extragenital Hard Chancres, Inguinal Lymphadenitis, and Systemic Symptoms

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