2022 Volume 115 Issue 9 Pages 779-782
Syphilis is a chronic systemic infection caused by Treponema pallidum, with a wide spectrum of symptoms depending on the disease stage and host condition. Herein, we present the case of a patient with syphilitic lymphadenopathy who was initially suspected as having malignant lymphoma.
A 27-year-old man presented to our hospital with a swelling in the left submandibular region that had gradually increased in size over the previous one month. Blood tests showed increased C-reactive protein (CRP) and soluble IL-2 receptors. Neck ultrasonography revealed a well-defined mass measuring 2 cm in diameter. Contrast-enhanced cervical CT showed a well-defined mass, consistent with the findings of ultrasonography, and the patient was diagnosed as having submandibular lymphadenopathy. Fine needle aspiration cytology from the lymph node revealed a mixture of medium to large lymphocytes, but mainly small lymphocytes. The patient was suspected as having malignant lymphoma, and scheduled for lymph node biopsy under general anesthesia. However, the biopsy was suspended on account of the patient having fever, sore throat, and rose spots in the anterior chest at admission. Blood examination conducted for suspected syphilitic lymphadenitis revealed TPHA qualitative (+), syphilis RPR (+), and syphilis RPR: 25.1 R.U. Thus, a final diagnosis of left submandibular lymph node enlargement due to stage 2 syphilis was made, and the patient was started on systemic antibiotic therapy.
Unlike general bacterial infections, syphilitic lymphadenitis is characterized by the absence of pain or inflammatory symptoms, and early lesions resolve spontaneously, which could easily be mistaken for spontaneous healing. In addition, early syphilis can present with a variety of non-specific symptoms, and malignant lymphoma may be suspected, leading to unnecessary biopsy. Therefore, it is important to keep in mind the possibility of syphilitic lymphadenitis in patients presenting with cervical lymphadenopathy, with careful attention paid to the history and clinical findings.
