Secondary Pulmonary Syphilis: Report of A Likely Case and Literature Review

Abstract

We report the case of a homosexual, HIV-positive man with typical secondary syphilis and multiple excavated pulmonary subpleural nodules. Syphilis with direct pulmonary involvement was suggested by a positive result of PCR of a bronchoalveolar lavage fluid specimen, then confirmed by a positive therapeutic test result. Only 9 reports of pulmonary involvement in secondary syphilis have been reported to date in the English-language literature. Clinicians should be aware of this atypical localization of syphilis.

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

“…Identification of spirochetes in bones or lungs often proved difficult. They were only rarely seen by darkfield microscopy or on Warthin-Starry-stained biopsies 2 4. Access to new diagnostic tools during the last decades, such as PCR, CT scan and MRI, might soon reveal that bone and lung involvement is not as rare as previously thought in secondary syphilis.…”

“…In 2006, David et al 4 reviewed nine cases of secondary pulmonary syphilis that had been published in the English language literature since 1967. We could find eight more English language case reports from 2009 to 2014 5–12.…”

Answer

“…Interestingly, eight of the nine patients had single or multiple lesions at lower lung regions 2. Our patient with diagnosed secondary syphilis also had bibasilar lesions and alternative possible aetiologies for pulmonary lesions were excluded, both microbiologically and histologically.…”

“…David and colleagues2 recently reviewed nine cases published since 1967 which met the Coleman criteria for the diagnosis of secondary pulmonary syphilis (ie, physical findings of secondary syphilis, serological diagnosis, radiological lung abnormalities, exclusion of other forms of pulmonary disease and resolution of radiological abnormalities following anti-syphilis treatment) 3. Interestingly, eight of the nine patients had single or multiple lesions at lower lung regions 2.…”

Sífilis secundaria con afectación pulmonar

“…La sintomatología de la SS pulmonar suele ser inespecífica y a menudo subclínica, siendo el dolor torá cico y la tos seca los síntomas má s comunes 3 pacientes es la presencia en la mitad de los casos de una hepatitis, a menudo colestá sica, lo que corrobora el cará cter sisté mico de la infecció n. El patró n radioló gico muestra, en la mayoría de los casos, nó dulos pulmonares, por lo general mú ltiples, aunque tambié n se han descrito masas, infiltrados intersticiales y derrame pleural 3,4 . Nuestra observació n clínica es el segundo caso descrito de lesió n seudotumoral 8 .…”