Abstract
A case of gastric lesions associated with acquired syphilis in the secondary period is reported. A 48-year-old man admitted to our hospital because of epigastric pain, anorexia and 3 kg weight loss in the past two weeks. A slightly increased white blood, 7, 000/mm3, with an increased erythrocyte sedimentation rate of 40 mm/hour and hypoproteinemia were found. Blood serological test for syphilis was positive, but no syphilic eruptions were observed on the skin. Roentogenography and gastrofiberscopy revealed four shallow and irregular shaped ulcers on the posterior wall of the lower gastric body (Figure 2, 3 and 6, 7). The margin of the ulcers were clear with redness and the surrounding mucosa was edematous. HE stained histologic specimens biopsied from the margin of the ulcers showed non-specific findings, inf iltrations of lymphocytes, plasma cells and eosinophiles. From the roentgeno-graphic, gastroscopic and histologic findings, the gastric lesions were diagnosed as multiple peptic ulcers and those lesions were healed with cimetidine, pirenzepin and sucralphate (Figure 8). However, pharyngeal pain still continued after healing of the gastric ulcers and a careful examination of the oral cavity revealed syphilitic stomatitis and tonsillitis. Then the biopsied specimens obtained in the endoscopy series were stained by Ohtani's method, which is a kind of silver stains for Treponema pallidum. Many Treponema pallidum were seen in the specimens taken by the first endoscopy after hospitalization (Figure 10). And in the specimen biopsied on the twenty first hospital day, only a few Treponema pallidum were observed in spite of no treatment for syphilis (Figure 11). Finally, the gastric ulcers were healed without treatment for syphilis. Disappearance of the gastric lesions was similar to that of skin eruption usually observed in the secondary period of the disease although an effect of anti-peptic ulcer drugs on the ulcer healing was not disregarded. After healing of the gastric ulcers, penicillin was administered and the blood serological test for syphilis was significantly improved. From these findings, we considered that the gastric lesions of the present case formed during the secondary period of acquired syphilis. And gastric lesions associated with early syphilis might spontaneously disappear without treatment for syphilis.
