2025 Volume 67 Issue 1 Pages 40-46
A man in his 20s was referred to our hospital with anorectal pain and bloody stools. A colonoscopy revealed a hemorrhagic ulcer in the lower anterior wall of the rectum, lymphofollicular hyperplasia, and longitudinal erosion in the terminal ileum. Biopsy revealed a non-caseating epithelioid cell granuloma, and Crohnʼs disease was suggested as a differential diagnosis. Blood tests were positive for syphilis serodiagnosis, and pathological specimens were positive for antibodies against treponema of syphilis. Stage Ⅱ syphilis was diagnosed based on a history of anal intercourse with a man and skin and pubic findings. The patient was started on AMPC (1,500mg/day), and his skin rash and abdominal symptoms resolved. Three months later, scarring of a rectal ulcer was observed. The incidence of syphilis is increasing in Japan, and the chances of encountering syphilitic enterocolitis are assumed to increase. Therefore, understanding the pathophysiology and endoscopic findings is crucial, and a detailed history-taking and systemic examination should be performed if syphilitic enterocolitis is suspected.
