Provincial Hospital of Zagora Zagora, Souss-Massa-Dr, Morocco
Award: Presidential Poster Award
Soukaina El Yazal, MD1, Pearl Aggarwal, MD2, Saqr Alsakarneh, MD3, Farah A. Khraisat, MD4, Fazel Dinary, MD2 1Provincial Hospital of Zagora, Zagora, Souss-Massa-Dr, Morocco; 2University Hospitals St. John Medical Center, Westlake, OH; 3University of Missouri-Kansas City, Kansas City, MO; 4Jordan University Hospital, Queen Rania St., 'Amman, Jordan
Introduction: Colorectal Syphilis is a rare presentation of the widely recognized sexually transmitted disease and often misdiagnosed as other colorectal diseases. Here, we present 2 cases and a review of literature of cases with colorectal syphilis.
Case Description/Methods: Case 1
A 50 y/o male was referred to the clinic for screening colonoscopy. Physical exam revealed bilateral non-tender inguinal lymphadenopathy. Lab tests showed anemia (Hb: 8.7 g/dL) and thrombocytosis (platelet: 1,067 K/uL). Colonoscopy showed serpiginous AV malformations-like structures in the cecum and ascending colon, and round white lesions in the rectum. Both rectal and cecal biopsies were performed. Spirochetes along the apical surface of the colonic mucosa was demonstrated by Warthin- Starry Silver stain. Further questioning revealed an episode of rectal intercourse 3 months before presentation. Both reactive TPHA and RPR were positive. Primary rectal syphilis diagnosis was made. The patient was treated with IM Penicillin G Benzathine which induced rapid regression of the rectal ulcer.
Case 2
A 46 y/o male presented with intermittent rectal bleeding, anal pain, and 20 lbs weight loss within 6 months. Physical exam showed bilateral non-tender inguinal lymphadenopathy. Lab tests showed Hb of 13 g/dL and platelet count of 275 K/uL. Outpatient colonoscopy showed rectal circumferential ulcerated mass with friable surface and diffuse abnormal erosive mucosa. Biopsy of the rectal mass showed extensive chronic inflammatory changes, including dense groups of plasma cells and granulation tissue formation. On H&E stain, there was evidence of spirochetes along the surface epithelium. EUS of the rectum showed an irregular hyperechoic lesion. Fine-needle biopsy showed mononuclear cells infiltrate with prominent polyclonal plasma cells raising the possibility of syphilis infection. Further questioning revealed that the patient had recurrent receptive rectal sexual intercourse. Both reactive TPHA and RPR were positive. The patient was diagnosed with primary rectal syphilis and treated with one dose of IM Penicillin G Benzathine which induced rapid regression of the rectal ulcers and bleeding.
Discussion: In our review, rectal bleeding was the most common symptom 80%, and rectal involvement was more common than colonic involvement. Colonoscopic findings include ulcers, tumor-like masses, erythema, and erosions. Histology shows inflammatory infiltrate and occasional granulomas. Most cases achieved resolution after treatment with penicillin.
Figure: CASE 1: A&B: colonoscopy view of multiple white spots in the rectum, C: AV Malformations in the cecum, D: AV malformations in the ascending colon, E: H&E section of colonic mucosa showing bluish fringe across the apical surface, composed of filamentous structures, F: Warthin Starry stain highlights various filamentous organisms consistent with spirochetes (blue arrows). CASE 2- G&H: colonoscopy view of rectal mass with surrounding friable abnormal mucosa, I&J: H&E and Warthin Starry stain showing multiple spirochetes along the surface epithelium (blue arrow). K: H&E of the rectal mass shows ulcer with extensive acute and chronic inflammation including dense groups of plasma cells and granulation tissue. L: Warthin Starry stain showing a few tissue infiltrating spirochete organisms (blue arrow).
Disclosures:
Soukaina El Yazal indicated no relevant financial relationships.
Pearl Aggarwal indicated no relevant financial relationships.
Saqr Alsakarneh indicated no relevant financial relationships.
Farah A. Khraisat indicated no relevant financial relationships.
Fazel Dinary indicated no relevant financial relationships.
Soukaina El Yazal, MD1, Pearl Aggarwal, MD2, Saqr Alsakarneh, MD3, Farah A. Khraisat, MD4, Fazel Dinary, MD2. P3116 - Navigating Uncommon Presentations of Colorectal Syphilis: Case Series and Literature Review, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
