Rectal syphilis - A case report

Dimitrije Damjanov; Tatiana Jocić; Olgica Latinović-Bošnjak; Dragomir Damjanov; Željka Savić; Dijana Kosijer; Vladimir Vračarić; Tihomir Orlić; Žarko Krnetić

doi:10.2298/VSP171023189D

Dimitrije Damjanov University of Novi Sad, Faculty of Medicine, Department of Internal Medicine, Novi Sad, Serbia; Clinical Centre of Vojvodina, Clinic for Gastroenterology and Hepatology, Novi Sad, Serbia
Tatiana Jocić Clinical Centre of Vojvodina, Clinic for Gastroenterology and Hepatology, Novi Sad, Serbia
Olgica Latinović-Bošnjak University of Novi Sad, Faculty of Medicine, Department of Internal Medicine, Novi Sad, Serbia; Clinical Centre of Vojvodina, Clinic for Gastroenterology and Hepatology, Novi Sad, Serbia
Dragomir Damjanov University of Novi Sad, Faculty of Medicine, Department of Internal Medicine, Novi Sad, Serbia; Clinical Centre of Vojvodina, Clinic for Gastroenterology and Hepatology, Novi Sad, Serbia
Željka Savić University of Novi Sad, Faculty of Medicine, Department of Internal Medicine, Novi Sad, Serbia; Clinical Centre of Vojvodina, Clinic for Gastroenterology and Hepatology, Novi Sad, Serbia
Dijana Kosijer University of Novi Sad, Faculty of Medicine, Department of Internal Medicine, Novi Sad, Serbia; Clinical Centre of Vojvodina, Clinic for Gastroenterology and Hepatology, Novi Sad, Serbia
Vladimir Vračarić University of Novi Sad, Faculty of Medicine, Department of Internal Medicine, Novi Sad, Serbia; Clinical Centre of Vojvodina, Clinic for Gastroenterology and Hepatology, Novi Sad, Serbia
Tihomir Orlić Clinical Centre of Vojvodina, Clinic for Gastroenterology and Hepatology, Novi Sad, Serbia
Žarko Krnetić University of Novi Sad, Faculty of Medicine, Department of Internal Medicine, Novi Sad, Serbia; Clinical Centre of Vojvodina, Clinic for Gastroenterology and Hepatology, Novi Sad, Serbia

DOI: https://doi.org/10.2298/VSP171023189D

Keywords: diagnosis, differential, homosexuality, inflammatory bowel diseases, rectal diseases, sexually transmitted diseases, syphilis, treatment outcome

Abstract

Abstract

Introduction. Syphilis rarely affects anorectal region. The symptoms are nonspecific and are commonly disregarded in our country. Therefore, they pose a difficulty both for a diagnosis and for a treatment.We presented a patient with the clinical, laboratory, endoscopic and histological characteristics of rectal siphilis who was initially suspected to have inflammatory bowel disease. Case report. A 29-year-old man was hospitalized with a suspected inflammatory bowel disease, with symptoms such as frequent blood-stained diarrhea, lower abdominal pain and a loss of appetite. The physical examination showed maculopapular skin rash on the body. The ileocolonoscopic examination revealed finely granulated rectal mucosa, the loss of vascular pattern, and at 3 cm from the anal verge, an exulcerated submucosal lesion 1.2 cm in diameter, with two smaller, similar looking lesions. The histological examination of biopsies showed diffuse inflammatory-cell infiltration, with cryptitis, Paneth cell metaplasia with granuloma without caseous necrosis, which was highly suggestive of Crohn’s disease. The Treponema pallidum test results were positive [hemagglutination assay (TPHA)] with a titer 1 : 2,560 and the rapid plasma reagin test (RPR) with a titer 1 : 16. The ensuing detailed anamnesis on the patient’s sexual behavior showed that the patient had unprotected anal sexual relation with another man and the diagnosis of secondary syphilis was confirmed. After the treatment with benzathine penicillin G once a week, during a three-week period, the patient had no symptoms and had normal inflammatory markers, with a significant decrease of RPR titre and normal mucosa on rectosigmoidoscopy. Conclusion. Taking in consideration the variable clinical and endoscopic manifestations of this disease, it is necessary to take a detailed history of sexual behavior, since it can be crucial for determining the diagnosis and differential diagnosis of siphilis.

References

REFERENCES

Hamlyn E, Taylor C. Sexually transmitted proctitis. Postgrad Med J 2006; 82(973): 733–6.

Zhao WT, Liu J, Li YY. Syphilitic proctitis mimicking rectal cancer: A case report. World J Gastrointest Pathophysiol 2010; 1(3): 112–4.

Pisani Ceretti A, Virdis M, Maroni N, Arena M, Masci E, Magenta A, et al. The Great Pretender: Rectal Syphilis Mimic a Cancer. Case Rep Surg 2015; 2015: 434198.

Janier M, Hegyi V, Dupin N, Unemo M, Tiplica GS, Potočnik M, et al. 2014 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol 2014; 28(12): 1581–93.

Chapel TA, Prasad P, Chapel J, Lekas N. Extragenital syphilitic chancres. J Am Acad Dermatol 1985; 13(4): 582–4.

Golušin Z. Venerology. Novi Sad: Faculty of Medicine, University of Novi Sad; 2014. (Serbian)

Cha JM, Choi SI, Lee JI. Rectal syphilis mimicking rectal cancer. Yonsei Med J 2010; 51(2): 276–8.

Adachi E, Koibuchi T, Okame M, Sato H, Imai K, Shimizu S, et al. Case of secondary syphilis presenting with unusual complications: syphilitic proctitis, gastritis, and hepatitis. J Clin Microbiol 2011; 49(12): 4394–6.

Yilmaz M, Memisoglu R, Aydin S, Tabak O, Mete B, Memisoglu N, et al. Anorectal syphilis mimicking Crohn's disease. J Infect Chemother 2011; 17(5): 713–5.