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Infectious Syphilis Mimicking Neoplastic Disease

Infectious Syphilis Mimicking Neoplastic Disease Abstract Five patients who were initially evaluated for malignant neoplasm actually had infectious syphilis (one primary, two secondaries, two secondaries with persistence of primary). Two patients were considered for radical surgery and one for extensive radiation and/or chemotherapy. In four patients an elevated routine admission VDRL was the first indication of the correct diagnosis. Dark-field examination is the most important laboratory test in the diagnosis of primary syphilis; VDRL and FTA-ABS are most important in confirming secondary syphilis. Penicillin remains the drug of choice for therapy. At a time when the incidence of sexually transmitted diseases is increasing, it is extremely important to develop adequate educational programs for medical students and physicians. (Arch Intern Med 137:156-160, 1977) References 1. VD Fact Sheet 1975 , publication (CDC) 76-8195, US Department of Health, Education and Welfare, Public Health Service, 1975, p 10. 2. Fleming WL, Brown WJ, Donohue JF, et al: National survey of venereal disease treated by physicians in 1968 . JAMA 211:1827-1830, 1970.Crossref 3. Morgagni JB: Of chirurgical and universal disorders , in Alexander B (ed): The Seats and Causes of Diseases . London, A Millar and T Cadell, 1769, vol 3, p 356. 4. Osier W: Epitomes , in Bean WB (ed): Osler Aphorisms , New York, Henry Schuman Inc, 1950, p 134. 5. Drusin LM: The diagnosis and treatment of infectious and latent syphilis . Med Clin North Am 56:1161-1174, 1972. 6. Nazemi MM, Musher DM, Schell RF, et al: Syphilitic proctitis in a homosexual . JAMA 231:389, 1975.Crossref 7. Drusin LM, Homam WP, Dineen P: The role of surgery in primary syphilis of the anus . Ann Surg 184:65-67, 1976.Crossref 8. Goffinet DR, Hoyt C, Eltringham JR: Secondary syphilis misdiagnosed as lymphoma . Calif Med 112:22,23, 1970. 9. Evans N: Lymphadenitis of secondary syphilis: Its resemblance to giant follicular lymphadenopathy . Arch Pathol 37:175-179, 1944. 10. Baker AL, Kaplan MM, Wolfe HJ, et al: Liver disease associated with early syphilis . N Engl J Med 284:1422-1423, 1971.Crossref 11. Lee RV, Thornton GF, Conn HO: Liver disease associated with secondary syphilis . N Engl J Med 284:1423-1424, 1971.Crossref 12. Bhorade MS, Carag HB, Lee HJ, et al: Nephropathy of secondary syphilis . JAMA 216:1159-1166, 1971.Crossref 13. Bauer TJ, Price EV, Cutler JC: Spinal fluid examinations among patients with primary or secondary syphilis . Am J Syph 36:309-318, 1952. 14. Merritt HH, Adams RD, Solomon HC: Neurosyphilis . New York, Oxford University Press, 1946, pp 28-32. 15. Garson W, Portnoy J, Bossak HN, et al: Darkfield Microscopy for the Detection and Identification of Treponema pallidum . US Public Health Service Publication 990, 1962, pp 1-13. 16. Jaffe HW: The laboratory diagnosis of syphilis . Ann Intern Med 83:846-850, 1975.Crossref 17. Schroeter AL, Lucas JB, Price EV, et al: Treatment for early syphilis and reactivity of serologic tests . JAMA 221:471-476, 1972.Crossref 18. Syphilis—CDC Recommended Treatment Schedules 1976 . Morbidity Mortality Weekly Rep 25:101,102,107, 1976. 19. Report of the National Commission on Venereal Disease , publication (HSM) 72-8125, US Department of Health, Education and Welfare, Public Health Service, 1972, pp 11-17. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1977 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1977.03630140012006
Publisher site
See Article on Publisher Site

Abstract

Abstract Five patients who were initially evaluated for malignant neoplasm actually had infectious syphilis (one primary, two secondaries, two secondaries with persistence of primary). Two patients were considered for radical surgery and one for extensive radiation and/or chemotherapy. In four patients an elevated routine admission VDRL was the first indication of the correct diagnosis. Dark-field examination is the most important laboratory test in the diagnosis of primary syphilis; VDRL and FTA-ABS are most important in confirming secondary syphilis. Penicillin remains the drug of choice for therapy. At a time when the incidence of sexually transmitted diseases is increasing, it is extremely important to develop adequate educational programs for medical students and physicians. (Arch Intern Med 137:156-160, 1977) References 1. VD Fact Sheet 1975 , publication (CDC) 76-8195, US Department of Health, Education and Welfare, Public Health Service, 1975, p 10. 2. Fleming WL, Brown WJ, Donohue JF, et al: National survey of venereal disease treated by physicians in 1968 . JAMA 211:1827-1830, 1970.Crossref 3. Morgagni JB: Of chirurgical and universal disorders , in Alexander B (ed): The Seats and Causes of Diseases . London, A Millar and T Cadell, 1769, vol 3, p 356. 4. Osier W: Epitomes , in Bean WB (ed): Osler Aphorisms , New York, Henry Schuman Inc, 1950, p 134. 5. Drusin LM: The diagnosis and treatment of infectious and latent syphilis . Med Clin North Am 56:1161-1174, 1972. 6. Nazemi MM, Musher DM, Schell RF, et al: Syphilitic proctitis in a homosexual . JAMA 231:389, 1975.Crossref 7. Drusin LM, Homam WP, Dineen P: The role of surgery in primary syphilis of the anus . Ann Surg 184:65-67, 1976.Crossref 8. Goffinet DR, Hoyt C, Eltringham JR: Secondary syphilis misdiagnosed as lymphoma . Calif Med 112:22,23, 1970. 9. Evans N: Lymphadenitis of secondary syphilis: Its resemblance to giant follicular lymphadenopathy . Arch Pathol 37:175-179, 1944. 10. Baker AL, Kaplan MM, Wolfe HJ, et al: Liver disease associated with early syphilis . N Engl J Med 284:1422-1423, 1971.Crossref 11. Lee RV, Thornton GF, Conn HO: Liver disease associated with secondary syphilis . N Engl J Med 284:1423-1424, 1971.Crossref 12. Bhorade MS, Carag HB, Lee HJ, et al: Nephropathy of secondary syphilis . JAMA 216:1159-1166, 1971.Crossref 13. Bauer TJ, Price EV, Cutler JC: Spinal fluid examinations among patients with primary or secondary syphilis . Am J Syph 36:309-318, 1952. 14. Merritt HH, Adams RD, Solomon HC: Neurosyphilis . New York, Oxford University Press, 1946, pp 28-32. 15. Garson W, Portnoy J, Bossak HN, et al: Darkfield Microscopy for the Detection and Identification of Treponema pallidum . US Public Health Service Publication 990, 1962, pp 1-13. 16. Jaffe HW: The laboratory diagnosis of syphilis . Ann Intern Med 83:846-850, 1975.Crossref 17. Schroeter AL, Lucas JB, Price EV, et al: Treatment for early syphilis and reactivity of serologic tests . JAMA 221:471-476, 1972.Crossref 18. Syphilis—CDC Recommended Treatment Schedules 1976 . Morbidity Mortality Weekly Rep 25:101,102,107, 1976. 19. Report of the National Commission on Venereal Disease , publication (HSM) 72-8125, US Department of Health, Education and Welfare, Public Health Service, 1972, pp 11-17.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Feb 1, 1977

References