Unusual Presentation of Secondary Syphilis in Korea: 2010-2014 Review

Dan Song; Jae Heon Kim

doi:10.14777/kjutii.2015.10.1.19

Journal List > Korean J Urogenit Tract Infect Inflamm > v.10(1) > 1059905

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Song and Kim: Unusual Presentation of Secondary Syphilis in Korea: 2010-2014 Review

Review

Korean J Urogenit Tract Infect Inflamm 2015;10(1):19-24.

Published online: 17 April 2015

DOI: https://doi.org/10.14777/kjutii.2015.10.1.19

Unusual Presentation of Secondary Syphilis in Korea: 2010-2014 Review

Dan Song, Jae Heon Kim

Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea

Correspondence to: Jae Heon Kim, http://orcid.org/0000-0002-4490-3610, Department of Urology, Suncheonhyang University Seoul Hospital, Suncheonhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-gu, Seoul 140-743, Korea Tel: +82-2-709-9378, Fax: +82-2-709-9378 E-mail: piacekjh@hanmail.net

Received 28 October 2014 Revised 9 November 2014 Accepted 9 November 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The prevalence of syphilis differs according to the object and district. Diagnosis of syphilis remains challenging, as the absence of classical features of disease, such as the secondary syphilis orogenital lesion rash, might make accurate diagnosis difficult. However, recent studies have reported a growing prevalence of symptomatic syphilis in Korea. The main reason is the rise in primary and secondary syphilis. The most common clinical features of primary and secondary syphilis are orogenital lesions, masculopapapular rash, and generalized lymphadenopathy. An increasing number of unusual clinical presentations have been reported among secondary syphilis cases. The aim of this study was to remind us of the significance of syphilis by highlighting the unusual clinical presentation of secondary syphilis.

Keywords: Secondary syphilis

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Table 1.

Unusual presentation of secondary syphilis in Korea

Author, year	Sex	Age (y)	Chief complaint	Clinical presentation	Orogenital lesion	Serologic marker (quantity)	Fluorescent treponemal antibody test/ hemagglutination	Confirmation of Treponema pallidum	Remark
Park et al. 20146	M	41	Back pain for 1 month Weight loss for 3 months	Maculopapular rash, including the palms and soles, in association with generalized lymphadenopathy	No	RPR 1:64	Positive	Not detected	MRI of the lumbar spine revealed bone destruction and extraskeletal soft tissue formation at the right side of the L5 vertebral body
Park et al. 201318	M	45	Progressive weakness, hair loss, anorexia, 10-kg weight loss, and night sweats for 3 months	Nontender and freely movable bilateral inguinal lymph node was palpated.	Yes, one month ago	VDRL 1:32	Positive	Detected	CT revealed several enlarged lymph nodes in porta hepatitis; gastrohepatic, perigastric, aortocaval areas; splenic hilum; and mesenteric and both inguinal areas.
Kim et al. 201019	M	42	Malaise and jaundice for one month	Icteric sclera and tender hepatomegaly macular and papular lesions, about 0.5 cm in diameter, localized on the trunk, palms, and soles	No	VDRL >1:1,024	Positive	Not detected	Mildly enlarged liver, nonspecifically enlarged lymph nodes at the porta hepatis area, and thickened gall bladder wall
Jang et al. 201130	M	46	Raised skin lesion on his scalp for one month	Scalp lesion was a 1′1 cm single erythematous scaly nodule on the occiput	No	VDRL 1:128	Positive	Detected	Numerous spirochetes in the epidermis and at the dermoepidermal junction
Kim et al. 201337	M	51	Chest pain, fever, and myalgia for 2 weeks	Erythematous papular rash on the trunk, right cervical, and bilateral inguinal nontender, nonmovable lymphadenopathy was noted	Yes, 6 weeks earlier	VDRL 1:64	Positive	Not detected	CT scan showed multiple variably sized nodules in both lungs, suggesting the possibility of a hematogenous metastatic malignancy
Yoon et al. 201343	F	59	Speech disturbance for 20 days	Congnitive disturbance and dysarthria	Yes, 2 months earlier	VDRL 1:16	Positive	Not detected	First presentation was diagnosed as unknown brain tumor but secondary syphilis was diagnosed at secondary presentation
Jo et al. 201349	M	22	Recurrent oral ulcers, genital erosions for several months	Multiple elliptical crusted erosions are found on the scrotum. Crops of hyperpigmented tender nodules are located on both shins	Yes	Not mentioned	Positive	Detected	Initial diagnosis was Behçet's disease

M: male, F: female, RPR: rapid plasma reagin, VDRL: venereal disease research laboratory test, MRI: magnetic resonance imaging, CT: computed tomography.

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