Secondary Syphilis with Tonsillar and Cervical Lymphadenopathy and a Pulmonary Lesion Mimicking Malignant Lymphoma

Abstract

Patient: Male, 27Final Diagnosis: Secondary syphilisSymptoms: Fever • loss of appetite • neck mass • night sweats • weight lossMedication: Oral amoxicillinClinical Procedure: Lymph node biopsySpecialty: Infectious DiseasesObjective:Challenging differential diagnosisBackground:Syphilis is a sexually transmitted disease caused by the pathogen Treponema pallidum. Prevalence continues to rise, especially among men who have sex with men (MSM). Due to changes in patterns of sexual activity, manifestations of the disease are highly variable.Case Report:A 27-year-old male visited the hospital for a low-grade fever and tender 5-cm mass in the right side of his neck. His right tonsil was swollen and covered with a white coating. Levofloxacin was prescribed, but ineffective. The patient’s levels of liver function enzymes increased gradually. Systemic magnetic resonance imaging (MRI) revealed bilateral cervical lymphadenopathy with right predominance, a right pulmonary nodule, and a periportal lymph node, suggestive of malignant lymphoma. However, a biopsy of the right cervical lymph node showed nonspecific inflammation. Preoperative rapid plasma reagin (RPR) and T. pallidum latex agglutination (TPLA) tests were positive. The patient was MSM and reported oral sex with many sexual partners. A diagnosis of secondary syphilis was made. Oral amoxicillin was effective, and all symptoms other than periportal lymph node resolved.Conclusions:Tonsillitis, cervical lymphadenopathy, and lung lesions can be manifestations of secondary syphilis. A detailed history, pathology, and serology are crucial for diagnosis.

Secondary syphilis with pulmonary involvement mimicking lymphoma: a case report

“…Although pulmonary involvement in cases of tertiary and congenital syphilis have been described, they have been rare in secondary syphilis 2,5 . Pulmonary lesions in secondary syphilis were first described in 1968 and may present as interstitial infiltrates, lung consolidation with or without pleural effusion and a solitary pulmonary nodule or multiple pulmonary nodules (most common finding) with or without cavitation 2,5 . Patients may be asymptomatic or present with respiratory symptoms, such as dry or productive cough and chest pain (most frequent symptom) 2 .…”

“…Lymphoma was suspected because of lymph node involvement and lung lesions, and an excisional axillary lymph node biopsy was performed. Cases of secondary syphilis presenting with extensive lymph node disease mimicking a lymphoma have been reported 2,5,10,12 ( Table 1). The five reported patients were men, and only one exhibited typical symptoms of syphilis, such as rashes on the hands and feet 2 .…”

“…The five reported patients were men, and only one exhibited typical symptoms of syphilis, such as rashes on the hands and feet 2 . Almost all cases presented with systemic symptoms, and two cases presented with pulmonary involvement 2,5 .…”

Special considerations in the diagnosis of syphilis in patients with atypical symptoms and extragenital localization of syphilides

“…Несмотря на то что наиболее частое и типичное заражение сифилисом ассоциируется с поражением гениталий, на высокую вероятность экстрагенитальной локализации сифилитических аффектов указывают многие зарубежные и отечественные авторы [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Если при первичном сифилисе экстрагени-Material and methods.…”

“…тальные сифилитические аффекты выявляют в среднем у 10-20% пациентов [5,7,8], то при вторичном от 1 / 3 до 1 / 2 всех больных имеют наружные проявления заболевания вне области гениталий [9]. Наиболее часто поражается слизистая оболочка губ, язык, слизистые оболочки твердого и мягкого неба [9][10][11][12]17], миндалины [17][18][19] Осмотр: кожные покровы туловища и конечностей без специфических проявлений сифилиса, в области уздечки полового члена выявлена эрозия мягкой консистенции, с отечностью, без инфильтрата в основан ии (рис. 1).…”