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Yu HJ, Kim SJ, Oh HH, Im CM, Han B, Myung E, Yun SJ, Lee KH, Joo YE. Case report of gastric syphilis in Korea: Clinical features, pathology, management, and prognosis. Medicine (Baltimore) 2021; 100:e28212. [PMID: 34918682 PMCID: PMC8678019 DOI: 10.1097/md.0000000000028212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/22/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Syphilis is a contagious infectious disease caused by Treponema pallidum. Gastric involvement of syphilis is rare and has nonspecific gastrointestinal symptoms and endoscopic findings. To date, 16 cases have been reported in Korea. Here, we report 2 additional cases of gastric syphilis in men in their 30 second. PATIENTS CONCERNS Two 35- and 33-year-old men presented with epigastric pain. DIAGNOSIS The serum venereal disease research laboratory and fluorescent treponemal antibody absorption tests were positive. Esophagogastroduodenoscopy showed multiple variable-sized flat elevated lesions and geographic ulcers with whitish exudates in the antrum and body. Warthin-Starry silver staining of endoscopic biopsy specimens confirmed gastric syphilis. INTERVENTIONS The patients were treated with an intramuscular injection of 2.4 million units of benzathine penicillin once a week for 3 weeks. OUTCOMES Clinical symptoms and gastric lesions were completely resolved. LESSONS First, gastric syphilis, despite its rarity and nonspecific symptoms and endoscopic findings, should be considered in a rare extracutaneous presentation of syphilis. Second, a high index of clinical suspicion and an accurate diagnosis based on a combination of clinical, radiological, endoscopic, serologic, and histopathologic findings provide an opportunity to identify and treat patients with gastric syphilis.
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Affiliation(s)
- Hyung-Joo Yu
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seong-Jung Kim
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Republic of Korea
| | - Hyung-Hoon Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Chan-Mook Im
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Bora Han
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Eun Myung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sook-Jung Yun
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Kyung-Hwa Lee
- Department of Pathology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Young-Eun Joo
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
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du Preez L, Ali N, Akselrod D, D'Agostino R. Shofar sign. Abdom Radiol (NY) 2021; 46:1768-1770. [PMID: 33057740 DOI: 10.1007/s00261-020-02645-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/23/2020] [Accepted: 07/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Liam du Preez
- University of Vermont Medical Center, Burlington, Vermont, USA
| | - Naiim Ali
- University of Vermont Medical Center, Burlington, Vermont, USA.
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Xiang H, Han J, Ridley WE, Ridley LJ. Ram’s Horn Sign: Gastric antrum in Crohn’s disease. J Med Imaging Radiat Oncol 2018; 62 Suppl 1:101. [DOI: 10.1111/1754-9485.45_12784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hao Xiang
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Jason Han
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | | | - Lloyd J Ridley
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Medical Imaging, University of Sydney, Sydney, New South Wales, Australia
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Abstract
Awareness of the spectrum of clinical manifestations of syphilis, especially uncommon changes, is essential for diagnosis and effective management of patients. A 48-year-old Han businessman presented to the ear, nose and throat surgeons with an eight-week history of epigastric pain, a four-week history of a widespread non-itchy rash including the scrotal skin and a one-week history of tinnitus and dizziness. On examination, he was afebrile with widespread lymphadenopathy and a maculopapular rash affecting his trunk and scrotum. His abdomen was soft but tender in the epigastrium. The Treponema pallidum particle agglutination assay result was positive, and the rapid plasma reagin was 1:2. Gastroscopy showed ulcers in the gastric antrum and pylorus. Histopathological examination of gastric mucosa lesions showed a large amount of lymphoplasmacytic infiltrate detected in the lamina propria of the gastric mucosa. The T. pallidum Liferiver real time polymerase chain reaction kit assay performed on specimens from skin lesions and gastric mucosal tissue were positive. The patient was treated with intravenous sodium penicillin followed by intramuscular benzathine penicillin. On the fourth day of the treatment, the rash, epigastric pain and lymphadenopathy subsided. Two weeks after treatment, the tinnitus alleviated and vertigo disappeared.
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Affiliation(s)
- Kuan Lai
- 1 Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | | | | | - Shanshan Wei
- 1 Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Kang Zeng
- 1 Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
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Kim YC, Chung YE, Lim JS. An uncommon cause of ulceroinfiltrative gastric wall thickening in a young patient. Gastroenterology 2012; 143:e6-e7. [PMID: 23010298 DOI: 10.1053/j.gastro.2012.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 03/25/2012] [Accepted: 04/16/2012] [Indexed: 12/02/2022]
Affiliation(s)
- Young Chul Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea; Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Eun Chung
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Seok Lim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
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Abstract
Introduction. Considered as a rare event, gastric syphilis (GS) is reported as an organic form of involvement. Low incidence of GS emphasizes the importance of histopathological analysis. Objective. We aim to characterize GS endoscopic aspects in an immunocompetent patient. Case Report. A 23-year-old man presented with epigastric pain associated with nausea, anorexia, generalized malaise and 11 kg weight loss that started 1 month prior to his clinical consultation. Physical examination was normal except for mild abdominal tenderness in epigastrium. Endoscopy observed diminished gastric expandability and diffuse mucosal lesions, from cardia to pylorus. Gastric mucosa was thickened, friable, with nodular aspect, and associated with ulcers lesions. Gastric biopsies were performed, and histopathological analysis resulted in dense inflammatory infiltration rich in plasmocytes. Syphilis serologies were positive for VDRL and Treponema pallidum reagents. Immunohistochemical tests were positive for Treponema pallidum and CD138. The patient was treated with penicillin, leading to resolution of his clinical complaints and endoscopic findings. Conclusion. Diagnosis suspicion of GS is important in view of its nonspecific presentation. Patients with gastric symptoms that mimic neoplastic disease should be investigated thoroughly based on the fact that clinical, endoscopic, and histological findings can easily be mistaken for lymphoma or plastic linitis.
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Ferreira-González L, Rubin EP, Álvarez-Fernández JC, Caínzos-Romero T. [Syphilitic gastritis: an aetiology to consider]. Enferm Infecc Microbiol Clin 2011; 30:105-7. [PMID: 22195974 DOI: 10.1016/j.eimc.2011.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 10/31/2011] [Accepted: 11/02/2011] [Indexed: 12/01/2022]
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Abstract
The authors conducted a systematic review of the English literature for cases of Gastric Syphilis (GS) in the last 50 years. The 34 studies which met selection criteria included 52 patients with GS. Of the reviewed patients, only 13% had a history of syphilis diagnosis and 46% had prior or concurrent clinical manifestations of the disease. Epigastric pain/fullness was the most common presenting symptom (92%) and epigastric tenderness being the most common sign. Gastric bleeding of variable intensity was documented in 35% of the cases. In the radiologic examinations, fibrotic narrowing and rigidity of the gastric wall was the most common finding (43%), followed by hypertrophic and irregular folds, while in endoscopy the most common lesion types were multiple ulcerations (48%), nodular mucosa, and erosions. The antrum was the most commonly affected area (56%). The majority of the patients received penicillin (83%) with a rapid resolution of their symptoms. Seventeen percent of the patients were treated surgically either due to a complication or due to strong suspicion of infiltrating tumor or lymphoma. The nonspecific clinical, radiologic, and pathologic characteristics of GS can establish it as a great imitator of other gastric diseases. GS should be considered in the differential diagnosis in patients at risk for sexually transmitted diseases who present with abdominal complaints and unusual endoscopic lesions and no other diagnosis is made, irrespective of the presence of H. pylori. The absence of primary or secondary luetic lesions should not deter one from considering GS.
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Mazzie JP, Wilson SR, Sadler MA, Khalili M, Javors BR, Weston SR, Katz DS. Imaging of Gastrointestinal Tract Infection. Semin Roentgenol 2007; 42:102-16. [PMID: 17394923 DOI: 10.1053/j.ro.2006.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Joseph P Mazzie
- Department of Radiology, St. Vincent's Catholic Medical Center-Manhattan, New York, NY, USA
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Guerrero AF, Straight TM, Eastone J, Spooner K. Gastric syphilis in an HIV-infected patient. AIDS Patient Care STDS 2005; 19:281-5. [PMID: 15916490 DOI: 10.1089/apc.2005.19.281] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Gastric syphilis in the setting of HIV is rare in the literature with only one other case reported. Herein, we present a case of a 40-year-old HIV-infected man with gastric syphilis. Evaluation revealed a rapid plasma reagin (RPR) of 1:2056, and cerebrospinal fluid with evidence of neurosyphilis. An esophagogastroduodenoscopy (EGD) was performed revealing nodular masses, which resolved after appropriate therapy with penicillin.
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Affiliation(s)
- A F Guerrero
- Uniformed Services University, Bethesda, Maryland, USA
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Abstract
A sexually transmitted disease is seldom considered in the differential diagnosis of patients with clinical gastritis. A patient with gastric syphilis is reported to alert emergency department physicians to this entity. History and physical findings of syphilis should be sought and rapid plasma reagin tests should be obtained in the patient with severe or refractory gastritis.
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Affiliation(s)
- J C Kolb
- University of Mississippi Medical Center, Jackson, USA
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Lichtenstein JE. INFLAMMATORY CONDITIONS OF THE STOMACH AND DUODENUM. Radiol Clin North Am 1993. [DOI: 10.1016/s0033-8389(22)00322-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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