1. Gastric syphilis displaying multiple annular lesions.
- Author
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Iwamuro M, Tanaka T, and Otsuka M
- Subjects
- Humans, Male, Middle Aged, Gastroscopy, Syphilis diagnosis, Syphilis pathology, Stomach Diseases microbiology, Stomach Diseases pathology, Stomach Diseases diagnostic imaging
- Abstract
Competing Interests: Disclosure All authors disclosed no financial relationships. Commentary Gastric syphilis is rare and presents in 1% of patients with syphilis. The most common presenting symptom is abdominal pain and fullness (92%), followed by nausea/vomiting (71%), weight loss (60%), and gastric bleeding (35%). Multisystem involvement may be seen, as with our patients who presented with a rash and chancre, but in up to two-thirds of patients, there may be no concurrent extraintestinal manifestation of syphilis. The endoscopic appearance typically consists of multiple annular ulcerations and erosions, sometimes with a purple/brown hue at the ulcer margin, as well as nodular mucosa, thickened gastric folds, and nondistensibility of the stomach. This presentation leaves the clinician with a broad differential diagnosis, including lymphoma, infiltrative tumors, Crohn’s disease, and tuberculosis, to name a few. Histologic examination can demonstrate a chronic gastritis with dense plasmacytic and lymphocytic infiltrate, proliferative endarteritis or endophlebitis, and perivascular cuffing. A high index of suspicion for T pallidum is needed to appropriately diagnose gastric syphilis with serologic testing and to detect spirochetes on gastric biopsy specimens with immunostaining, silver staining, dark field microscopy, or polymerase chain reaction. Treatment is prescribed based on the clinical stage of syphilis and results in full resolution of symptoms. The nonspecific clinical and endoscopic presentation of gastric syphilis indeed makes it “the great imitator” of other gastric diseases. Therefore, as highlighted in these cases, gastric syphilis should be suspected in high-risk patients who present with abdominal symptoms and unusual endoscopic findings. Early diagnosis can lead to prompt treatment and a significant decrease in syphilis-associated morbidity. Deepika Satish, MD, Assistant Professor of Medicine, Baylor College of Medicine, Houston, Texas, USA Amy Tyberg, MD, FASGE, FACG, Associate Editor for Focal Points
- Published
- 2024
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