대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Secondary syphilis with pulmonary involvement

Radiologic Findings

Chest CT images show multiple noncalcified nodules and cavities with GGO halo, which predominantly distribute in both lower lobes. On contrast enhanced CT images, the lung lesions show peripheral rim enhancement with internal low density.
The patient had a sexual contact in 2 months ago, and he has whole body erythematous macules, and urethritis.
On laboratory study, FTA-ABS IgG (+++) and VLRL (+) were detected.

Follow up CT scan after the Penicillin G 2.5 million units inject shows decreased size and number of nodules and cavities.

Brief Review

Syphilis is a sexually transmitted disease caused by Treponema pallidum. Syphilis with pulmonary involvement was limited to congenital and tertiary syphilis during the preantibiotic era but has been described as occurring mostly during secondary syphilis since 1967. Secondary pulmonary syphilis is very rare; 11 cases of pulmonary involvement in secondary syphilis have been reported until 2013. The imaging findings of secondary pulmonary syphilis are non-specific; subpleural nodular opacities (8/11), infiltrates (3/11), and pleural effusion (2/11). The clinical criteria proposed by Coleman et al. to diagnose pulmonary involvement secondary to syphilis; (1)historical and physical findings typical of secondary syphilis; (2) serologic test results positive for syphilis; (3) pulmonary abnormalities seen radiologically with or without associated symptoms or signs; (4) exclusion of other forms of pulmonary disease, when possible, according to findings of serological tests, sputum smears and cultures, and cytological examination of sputum; (5) response to antisyphilis therapy of signs found by radiological examination. After specific treatment, pulmonary symptoms resolved faster than did mucocutaneous signs, and radiological normalization took from 2 weeks to 4 months.

References

1. Kim SJ, Lee JH, Lee ES, et al. A case of secondary syphilis presenting as multiple pulmonary nodules. Korean J Intern Med. 2013 Mar;28:231-235.
2. David G, Perpoint T, Boibieux A, et al. Secondary pulmonary syphilis: report of a likely case and literature review. Clin Infect Dis. 2006 Feb 1;42: e11-e15.
3. Coleman DL, McPhee SJ, Ross TF, et al. Western Journal of Medicine. 1983;138:875-878

Keywords

Lung, Infection, Bacterial infection,