Syphilis Causing Lichenoid Esophagitis

Abstract

We present a 50-year-old woman with human immunodeficiency virus admitted to the hospital for melenic stools and anemia who underwent esophagogastroduodenoscopy for evaluation of upper gastrointestinal bleed. She is found to have inflammation of the esophagus with ulcerations and crater formation. A biopsy reveals severe inflammation with lymphocytic infiltrates with civatte bodies suggestive of lichenoid esophagitis with the presence of spirochetes (Treponema pallidum). The presence of syphilis in the esophagus causing lichenoid esophagitis is an extremely rare presentation that has never been reported.

Syphilis in the Esophagus

“…Gastric involvement is reported as a manifestation of secondary syphilis; however, ulcerations of the esophagus are a very rare manifestation of tertiary syphilis and in the modern era seem more frequently associated with HIV. 2 The presence of painful oral ulcers and odynophagia makes this case particularly unique. Treponema pallidum is a weakly antigenic and noninflammatory spirochete, evidenced by the classic painless chancre and gumma found with primary and secondary syphilis, respectively.…”

“…Gastric involvement is reported as a manifestation of secondary syphilis; however, ulcerations of the esophagus are a very rare manifestation of tertiary syphilis and in the modern era seem more frequently associated with HIV. 2…”