Work

Clinical and pathological features of gastric syphilis in a young woman: A case and literature review

Year: 2026

Type: article

Abstract: Background: Gastric syphilis is a rare manifestation of Treponema pallidum infection and an important mimic of gastric malignancy. Because its clinical, endoscopic, and histologic findings are nonspecific, diagnosis requires careful clinicopathologic correlation. Case Presentation: A 20-year-old woman presented with recurrent epigastric pain, nausea, and acid reflux. Examination revealed painless oral and nasal mucous patches. Serologic testing was positive for T. pallidum-specific antibody, with an RPR titer of 1:128. Gastroscopy showed multiple irregular ulcers with elevated margins and yellow exudates, raising concern for malignancy. Gastric biopsies demonstrated mucosal erosion, glandular injury, dense lymphoplasmacytic inflammation with a lymphocyte-predominant component, and small-vessel wall fibrosis. Immunohistochemistry for T. pallidum demonstrated numerous spirochetes within the gastric mucosa, supporting the diagnosis of gastric syphilis. The patient received benzathine penicillin G, and her gastrointestinal symptoms resolved within 5 days. Conclusion: Gastric syphilis is an important diagnostic mimic of gastric malignancy and lymphoproliferative disease. This case reinforces the recognized histologic spectrum of syphilitic gastritis and illustrates that plasma-cell predominance is not required for diagnosis. Correlation of a destructive inflammatory pattern and vascular changes with syphilis serology and T. pallidum immunohistochemistry can help establish the diagnosis and avoid unnecessary aggressive management.

Source: IDCases

DOI: 10.1016/j.idcr.2026.e02800