Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7 Iso, Hikami- cho, Tamba, 669-3495, Japan.
Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, Kobe, Hyogo, 652-0032, Japan.
BMC Pulm Med. 2023 May 18;23(1):170. doi: 10.1186/s12890-023-02469-6.
Syphilis is a chronic disease that progresses in the primary, secondary, latent, and tertiary stages. Pulmonary manifestations of syphilis are rare, and their histological features have not been well-described.
A 78-year-old man was referred to our hospital because of a solitary nodular shadow in the right middle lung field on a chest radiograph. Five years prior, a rash appeared on both legs. He was tested for syphilis at a public health center, and the non-treponemal test result was negative. When he was approximately 35 years old, he had unspecified sexual intercourse. Chest computed tomography showed a 13-mm nodule with a cavity in S6 of the right lower lobe of the lung. Robot-assisted resection of the right lower lobe was performed because of suspected localized right lower lobe lung cancer. A cicatricial variant of organizing pneumonia (CiOP) was observed, and immunohistochemistry identified Treponema pallidum inside the macrophages in the nodule cavity. The rapid plasma regain (RPR) value was negative, and the Treponema pallidum hemagglutination assay was positive. The patient was diagnosed as having secondary syphilis with pulmonary involvement. Insidious progression of secondary syphilis may result in CiOP and a negative RPR test result.
We report the first case of pulmonary syphilis with a histological pattern of CiOP. It may be asymptomatic and difficult to diagnose because the RPR test may be negative for a long period of time. When either non-treponemal or treponemal test results are positive, the possibility of pulmonary syphilis should be considered along with appropriate medical treatment.
梅毒是一种慢性疾病，可分为一期、二期、潜伏和三期。梅毒的肺部表现较为罕见，其组织学特征尚未得到很好的描述。
一名 78 岁男性因胸片显示右中肺野单发结节状阴影而被转诊至我院。五年前，他的双腿出现皮疹。他曾在公共卫生中心接受梅毒检测，非梅毒螺旋体检测结果为阴性。大约 35 岁时，他有过不明原因的性行为。胸部计算机断层扫描显示右肺下叶 S6 有一个 13 毫米的结节，伴有空洞。由于疑似局部右肺下叶肺癌，行机器人辅助右下肺叶切除术。观察到瘢痕组织性机化性肺炎（CiOP），免疫组织化学发现结节腔中的巨噬细胞内有梅毒螺旋体。快速血浆反应素（RPR）值为阴性，梅毒螺旋体血凝试验阳性。患者被诊断为二期梅毒合并肺部受累。二期梅毒的隐匿性进展可能导致 CiOP 和 RPR 检测结果阴性。
我们报告首例肺部梅毒的组织学表现为 CiOP。由于 RPR 检测可能在很长一段时间内呈阴性，因此可能无症状且难以诊断。当非梅毒螺旋体或梅毒螺旋体检测结果为阳性时，应考虑可能患有肺部梅毒，并进行适当的治疗。
