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Case Reports
. 2018 Mar 4:19:238-243.
doi: 10.12659/ajcr.907127.

Secondary Syphilis with Tonsillar and Cervical Lymphadenopathy and a Pulmonary Lesion Mimicking Malignant Lymphoma

Yukiko Komeno  1 , Yasunori Ota  2 , Tomohiko Koibuchi  3 , Yoichi Imai  4 , Kuniko Iihara  5 , Tomiko Ryu  1
Affiliations
Case Reports

Secondary Syphilis with Tonsillar and Cervical Lymphadenopathy and a Pulmonary Lesion Mimicking Malignant Lymphoma

Yukiko Komeno et al. Am J Case Rep. .

Abstract

BACKGROUND Syphilis is a sexually transmitted disease caused by the pathogen Treponema pallidum. Prevalence continues to rise, especially among men who have sex with men (MSM). Due to changes in patterns of sexual activity, manifestations of the disease are highly variable. CASE REPORT A 27-year-old male visited the hospital for a low-grade fever and tender 5-cm mass in the right side of his neck. His right tonsil was swollen and covered with a white coating. Levofloxacin was prescribed, but ineffective. The patient's levels of liver function enzymes increased gradually. Systemic magnetic resonance imaging (MRI) revealed bilateral cervical lymphadenopathy with right predominance, a right pulmonary nodule, and a periportal lymph node, suggestive of malignant lymphoma. However, a biopsy of the right cervical lymph node showed nonspecific inflammation. Preoperative rapid plasma reagin (RPR) and T. pallidum latex agglutination (TPLA) tests were positive. The patient was MSM and reported oral sex with many sexual partners. A diagnosis of secondary syphilis was made. Oral amoxicillin was effective, and all symptoms other than periportal lymph node resolved. CONCLUSIONS Tonsillitis, cervical lymphadenopathy, and lung lesions can be manifestations of secondary syphilis. A detailed history, pathology, and serology are crucial for diagnosis.

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Conflict of interest statement

Conflict of interest: None declared

Conflict of interest

None.

Figures

Figure 1.
Figure 1.
Systemic diffusion magnetic resonance imaging (MRI). (A) Whole-body image. Arrows show bilateral lymphadenopathy with right predominance. (B) Cervical lymph nodes. Central necrosis can be seen in the largest lymph node in the right neck (arrow). Arrowheads mark smaller lymph nodes in the left neck. (C) A nodule in the right lung (arrow). (D) A periportal lymph node (arrow).
Figure 2.
Figure 2.
Histopathology of the cervical lymph node. (A) Low magnification. The tissue consists of adipose tissue with fibrosis. Hematoxylin and eosin (H&E) stain. Original magnification, 40×. (B) Blood vessels surrounded by lymphocytes with mildly expanded nuclei. H&E stain. Original magnification, 400×.
Figure 3.
Figure 3.
Systemic diffusion magnetic resonance imaging (MRI) after amoxicillin treatment. Cervical lymph nodes are diminished.
See this image and copyright information in PMC

References

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