Komeno Yukiko, Ota Yasunori, Koibuchi Tomohiko, Imai Yoichi, Iihara Kuniko, Ryu Tomiko
Department of Hematology, Japan Community Healthcare Organization (JCHO), Tokyo Yamate Medical Center, Tokyo, Japan.
Department of Diagnostic Pathology, IMSUT Hospital of The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
Am J Case Rep. 2018 Mar 4;19:238-243. doi: 10.12659/ajcr.907127.
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.
背景 梅毒是一种由梅毒螺旋体病原体引起的性传播疾病。其患病率持续上升，尤其是在男男性行为者（MSM）中。由于性行为模式的变化，该疾病的表现高度可变。病例报告 一名27岁男性因低热和右侧颈部有压痛的5厘米肿块前往医院就诊。他的右侧扁桃体肿大，表面覆盖着白色分泌物。曾开具左氧氟沙星，但无效。患者的肝功能酶水平逐渐升高。全身磁共振成像（MRI）显示双侧颈部淋巴结病，右侧为主，右肺有一个结节以及一个肝门周围淋巴结，提示为恶性淋巴瘤。然而，右侧颈部淋巴结活检显示为非特异性炎症。术前快速血浆反应素（RPR）和梅毒螺旋体乳胶凝集试验（TPLA）呈阳性。该患者为男男性行为者，报告有多个性伴侣且有口交行为。诊断为二期梅毒。口服阿莫西林有效，除肝门周围淋巴结外的所有症状均得到缓解。结论 扁桃体炎、颈部淋巴结病和肺部病变可能是二期梅毒的表现。详细的病史、病理学和血清学检查对诊断至关重要。
