FIGURE 2 - uploaded by Pedro Alves da Cruz Gouveia
Content may be subject to copyright.
Histopathological findings of excisional lymph node biopsy, with expanded and "activated" lymphoid follicles and prominent germinative centers, consistent with reactive lymphadenopathy (hematoxylin and eosin; original magnification ×100).
Source publication
We present a case of atypical presentation of secondary syphilis with extensive lymph node involvement and pulmonary lesions, initially suspected as lymphoma. The patient presented with weight loss, dry cough, chest pain, palpable lymph nodes in several peripheral chains, and multiple pulmonary nodules and masses on chest imaging. The key features...
Contexts in source publication
Context 1
... a probable lymphoma, an excisional biopsy of the left axillary lymph node was performed. Histopathological and immunohistochemical studies were consistent with reactive lymphadenopathy, with centrofollicular hyperplasia and foci of progressively transformed germinal centers, and without evidence of neoplasia (Figure 2). ...
Context 2
... a probable lymphoma, an excisional biopsy of the left axillary lymph node was performed. Histopathological and immunohistochemical studies were consistent with reactive lymphadenopathy, with centrofollicular hyperplasia and foci of progressively transformed germinal centers, and without evidence of neoplasia (Figure 2). ...
Citations
... Multiple lung nodules with the halo sign due to syphilis Diogo Goulart Corrêa [1], [2] , Rodrigo Paulino [1] and Roberto Mogami [ A 26-year-old man presented with fever, a maculopapular rash on the chest and face, oral and genital ulcers, and cough for 2 weeks. Serological testing revealed positivity for human immunodeficiency virus, with a viral load of 18,218 copies/mL and a CD4 T lymphocyte count of 880 cells/mm 3 ...
FIGURE 1: Pulmonary syphilis in a 26-year-old man. (A-C) An axial chest CT scan showing multiple nodules in both lungs, some with peripheral ground-glass halos, constituting the halo sign (arrows). A 26-year-old man presented with fever, a maculopapular rash on the chest and face, oral and genital ulcers, and cough for 2 weeks. Serological testing revealed positivity for human immunodeficiency virus, with a viral load of 18,218 copies/mL and a CD4 T lymphocyte count of 880 cells/mm 3. The Venereal Disease Research Laboratory test revealed serum positivity (1:512), and the fluorescent treponemal antibody absorption test was reactive. Chest computed tomography (CT) revealed multiple nodules in both lungs, some with peripheral ground-glass halos. The patient was treated with penicillin G. A chest CT performed 2 weeks after treatment showed resolution of all lesions (Figure 1). Pulmonary involvement may occur in the secondary stage of syphilis due to the hematogenous spread of Treponema pallidum or in the tertiary stage with gummas and/or fibrotic lesions 1. Our patient met the diagnostic criteria of pulmonary syphilis, which include typical findings of syphilis in other organs, positive serological findings, imaging abnormalities that cannot be explained by other conditions, and response to syphilis treatment 2. However, pulmonary syphilis can occur without the typical cutaneous lesions 3. The imaging findings of pulmonary syphilis include multiple nodules 2 and/or masses 3 simulating primary
Syphilis is a multisystem infection caused by the spirochete Treponema pallidum . A 63-year-old man admitted to the hospital with chest pain and rashes on the chest wall and hands for 14 days. Thorax computed tomography revealed multiple nodular shadows in the bilateral lower lobes of the lung. Skin lesions were considered compatible with secondary syphilis.
The antibody test for syphilis was positive. Screening for other associated sexually transmitted diseases (serology for HIV, hepatitis C, and hepatitis B) was negative. A specific therapy with crystallized penicillin G 2.4 MIU was applied. The key features for secondary syphilis diagnosis were positive serologic tests for syphilis and complete recovery on thorax computed tomography after antisyphilitic treatment. Pulmonary involvement in secondary syphilis is considered a rare occurrence.
We discuss a case of secondary syphilis with pulmonary involvement in a 45-year-old man who tested positive for HIV. He presented with dyspnoea, chest pain and a rash on his limbs and torso. A CT showed multiple bilateral necrotic lung nodules. A diagnosis of pulmonary syphilis was made due to his respiratory symptoms and imaging, his serological, histopathology findings, and the resolution of symptoms on treatment with benzathine penicillin.
A 46-year-old man presented with nonproductive cough and lower limb swelling. Chest radiograph showed a left lower lobe lung mass and multiple subpleural nodules. Other investigations revealed that he had nephrotic syndrome. Core biopsies of the left lower lobe lung mass showed features of inflammatory pseudotumor with endarteritis obliterans and a lymphoplasmacytic infiltrate. Immunohistochemical stain for Treponema pallidum was positive. Resolution of the lung mass and nephrotic syndrome was achieved after treatment with intramuscular benzathine benzylpenicillin. The differential diagnosis of pulmonary inflammatory pseudotumor, manifestations of pulmonary syphilis, and a literature review of secondary syphilis of the lung are discussed.
