Answer Clinical Challenge 8

The correct answer is Syphilis gastritis.

  Gastric biopsies showed marked lymphoplasmacytic infiltrate with polymorphonuclear leukocytes in the submucosal layer. The Venereal Disease Research Laboratory test and fluorescent treponemal antibody absorbed tests were positive .The patient's boyfriend was tested and syphilis was confirmed. The patient and her boyfriend were treated with 3 shots of benzathine penicillin G injection (2,400,000 IU per injection) once a week for 3 weeks. After treatment, gastrointestinal symptoms were resolved.
  Syphilis is a sexually transmitted disease caused by the spirochetes Treponema pallidum. Syphilis can involve the skin, bone, central nervous system, and visceral organs. However, syphilitic gastritis is rare and difficult to diagnosis. It might occur in the second or third stage of untreated patients. It frequently occurs in younger males.
  OGD may show nonspecific findings such as diffuse oedema, erythema, erosions, and ulceration from fundus to antrum. In its early stages, syphilitic gastritis usually has no radiologic findings; however, as the infection progresses, diffusely thickened folds may become nodular with or without detectable ulcers and the inflammation results in fibrosis of the gastric wall. Syphilitic gastritis may mimic adenocarcinoma or lymphoma. Moreover, in its late stages, organisms are frequently difficult to detect in biopsy specimens. Upper gastrointestinal series show an “hourglass”- or “dumbbell”-shaped stomach owing to fibrotic narrowing. On computed tomography, hypertrophic and irregular fold thickenings are predominantly noted from the prepyloric antrum to the lower body. Patients with positive serologic findings require treatment with penicillin. After treatment, most of them (83%) demonstrate rapid resolution of their symptoms.

Further reading

Mylona, E.E., Baraboutis, I.G., Papastamopoulos, V. et al. Gastric syphilis: a systematic review of published cases of the last 50 years. Sex Transm Dis. 2010; 37: 177–183