HIV Insight: The Great Pretender: Rectal Syphilis Mimic a Cancer

Sunday, October 11, 2015

The Great Pretender: Rectal Syphilis Mimic a Cancer

Rectal syphilis is a rare expression of the widely recognised sexual transmitted disease, also known as the great imitator for its peculiarity of being confused with mild anorectal diseases because of its vague symptoms or believed rectal malignancy, with the concrete risk of overtreatment. We present the case of a male patient with primary rectal syphilis, firstly diagnosed as rectal cancer; the medical, radiological, and endoscopic features are discussed below....

A 48-year-old HIV-positive white male was admitted in our proctology outpatient clinic due to proctorrhagia arisen a few weeks before. Digital rectal examination revealed a palpable mass extended for 3 cm on the right-anterior wall of the rectum, 5 cm away from the anal verge....

Below: An endoscopic retroversion image of rectal ampulla showing an ulcerated lesion at the posterior commissure

Below: A single ulcer with regular edges and a lunate shape, occupying one-third of the visceral circumference

Below: (a) T2 weighted sagittal plan with isointense rectal wall thickness; (b) T1 weighted sagittal plan after gadolinium administration with homogeneous contrast enhancement of the rectal walls; (c) Axial diffusion-weighted image (b = 1000) with no hyper intensity of the rectal wall; (d) 18F FDG PET-CT with focal FDG accumulation in the rectal wall.