Syphilitic Pulmonary Inflammatory Pseudotumor: A Diagnostic Challenge

Govender, Dhirendra; Jackson, Christopher; Chetty,

doi:10.1177/1066896920928584

Cited by 4 publications

(8 citation statements)

References 49 publications

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“…Similar to previous reports, the histological features of the current case were chronic inflammatory processes with lymphoplasmacytic infiltration and hyalinized collagenous fibrotic scars [ 3 ]. The characteristic pathological finding of the current case was CiOP in the marginal area of the nodules.…”

Section: Discussionsupporting

confidence: 88%

“…Syphilis that affects the lungs is uncommon [ 3 , 7 ] and can be congenital, secondary, or tertiary in nature. Coleman et al proposed the following diagnostic criteria: physical and historical findings typical of syphilis, serological positivity for syphilis, pulmonary abnormalities on radiographs, exclusion of other forms of pulmonary disease, and radiologic response to antimicrobial therapy [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…pallidum . Lung biopsy was frequently not performed or included, and treatment was determined based on serological confirmation and related clinical characteristics [ 3 ]. Recently, there have been reports of pulmonary syphilis diagnoses, and the use of genetic techniques to treat these cases [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Clinical manifestations of secondary syphilis include rash and condyloma latum in intertriginous areas, lymphadenopathy, subclinical hepatitis, and systemic symptoms such as fever, malaise, and weight loss [ 2 ]. However, pulmonary manifestations of syphilis are rare, and their histological features have not been well-described [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary syphilis with a cicatricial variant of organizing pneumonia: a case report

et al. 2023

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Background Syphilis is a chronic disease that progresses in the primary, secondary, latent, and tertiary stages. Pulmonary manifestations of syphilis are rare, and their histological features have not been well-described. Case presentation A 78-year-old man was referred to our hospital because of a solitary nodular shadow in the right middle lung field on a chest radiograph. Five years prior, a rash appeared on both legs. He was tested for syphilis at a public health center, and the non-treponemal test result was negative. When he was approximately 35 years old, he had unspecified sexual intercourse. Chest computed tomography showed a 13-mm nodule with a cavity in S6 of the right lower lobe of the lung. Robot-assisted resection of the right lower lobe was performed because of suspected localized right lower lobe lung cancer. A cicatricial variant of organizing pneumonia (CiOP) was observed, and immunohistochemistry identified Treponema pallidum inside the macrophages in the nodule cavity. The rapid plasma regain (RPR) value was negative, and the Treponema pallidum hemagglutination assay was positive. The patient was diagnosed as having secondary syphilis with pulmonary involvement. Insidious progression of secondary syphilis may result in CiOP and a negative RPR test result. Conclusions We report the first case of pulmonary syphilis with a histological pattern of CiOP. It may be asymptomatic and difficult to diagnose because the RPR test may be negative for a long period of time. When either non-treponemal or treponemal test results are positive, the possibility of pulmonary syphilis should be considered along with appropriate medical treatment.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pulmonary syphilis with a cicatricial variant of organizing pneumonia: a case report

et al. 2023

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“…Generally, PIP may have a number of different causes. It is related to chronic inflammation; acquired immunodeficiency syndrome (AIDS), thymoma surgery, histoplasmosis, syphilis, and interferon treatment ( 5 ). However, it is exceedingly rare to have multiple lesions outside the lung (especially over the body).…”

Section: Discussionmentioning

confidence: 99%

A fatal multiple-lesion, inflammatory, pseudotumor in the lung: a rare case report

Li¹,

Zou²,

Gao³

et al. 2021

Transl Cancer Res TCR

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An inflammatory pseudotumor is considered a benign form of lesion marked by a proliferation of myofibroblasts with different degrees of inflammatory infiltrates. Pulmonary inflammatory pseudotumors (PIPs) are extremely rare in middle-aged adults. Normally, a PIP has a single lesion, and can be controlled constantly by surgery and drugs. In this paper, we report a case study of a 51-year-old male patient who presented with multiple inflammatory pseudotumors in lungs, thoracic spine, ribs, left humerusl, derived from PIPs throughout his body, which indicated a long disease term and significant recrudescence. After 6 surgeries (a wedge resection of the right lower lobe, a removal of three thoracic vertebral lesions, a removal of left humeral tumor lesion, a right lower lobe resection, local cryoablation of right lung, debridement of left upper-arm osteomyelitis and soft tissue infection), radiotherapy for lesions of left humerus destruction at a total dose of 20 Gy/10 F, and systematic treatments (30 mg prednisone acetate daily for 6 weeks, 50 mg compound cyclophosphamide tablets for 2 weeks; antibiotics, blood transfusions, nutritional support), his symptoms improved but reoccurred. The patient ultimately died of septic shock. Our case report highlights that the progression of a PIP to a malignant form requires further research. A multiple-lesion PIP that does not respond to systemic treatment can be highly dangerous.

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