Gastric syphilis most commonly affects young adults in the second to fourth decade of life. Epigastric pain, anorexia, nausea, vomiting and weight loss are common symptoms in gastric syphilis (2
), but there are no clear diagnostic criteria. The upper gastrointestinal tract series may reveal marked hourglass-like deformity of the pyloric region or the middle part of the stomach, mimicking linitis plastica, or obstruction of the gastric outlet (5
). The stomach may also be fixed and contrasted with thick rugae, as was the situation in the present case.
Gastroscopy may reveal purplish ulcer margins with necrosis accompanying edematous, friable mucosa with hemorrhages and atrophic, erosive, or infiltrative gastritis (4
). Gastric carcinoma must be considered in 85-95% of patients with gastric syphilis as in the present case.
The histologic diagnosis of syphilis is exceedingly difficult. Common histologic changes include thickened arterial walls with perivascular round cell infiltrates, and markedly thickened submucosa with diffuse infiltration of lymphocytes and plasma cells as well as endovasculitis. Chronic inflammation due to prominent plasma cells and lymphocytic infiltration suggests that syphilis be investigated as a potential cause. In present case, endovasculitis or hypertrophic arterial or venular walls were not prominent.
A fluorescent antibody test, the standard treponemal test in use today, is routinely performed to all the admissions at hospital. Serological testing is the most widely used laboratory technique for the diagnosis of syphilis. However, the VDRL test has a false-positive rate of around 1%, usually among patients with systemic lupus erythematosus or other autoimmune and connective tissue disease.
Spirochetes are not always obvious in endoscopic biopsy specimens in gastric syphilis (2
). Silver stains, immunofluorescent or immunoperoxidase stains for T. pallidum
are usually required to identify spirochetes (7
). Moreover, several studies have demonstrated that syphilis, and other genitalulcer diseases, are more common in HIV-infected persons. Recently, several reports have been issued on gastric syphilis (9
In summary, a high index of suspicion is important for this disease. Patients with gastric syphilis are typically young with symptoms mimicking a gastric neoplasm. Moreover, the clinical, endoscopic, and microscopic appearance of gastric syphilis may easily be confused with gastric lymphoma or linitis plastic carcinoma of the stomach. The most common symptoms of gastric syphilis are abdominal pain, nausea, vomiting, gastrointestinal bleeding, weight loss, early satiety and anorexia. The endoscopic appearance may vary from diffuse edema, erythema, friable or multiple erosions, to ulceration. Moreover, endoscopic gastric mucosal biopsies are often nonspecific histologically. If the clinician considers syphilis and obtains VDRL and FTA-ABS, a diagnosis can be confirmed. The patient may then be treated appropriately, and spared unnecessary surgery.