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A SO-Year-Old Man With Skin Lesions and Multiple Pulmonary Nodules: Patients

A SO-Year-Old Man With Skin Lesions and Multiple Pulmonary Nodules: PatientsAmong the protean clinical manifestations of syphilis, pulmonary involvement is unusual. While nodular (or gummatous) and fibrotic lesions of the lung (usually with pleural involvement) are well established yet uncommon complications of tertiary syph-ilis, pulmonary involvement in secondary syphilis is extremely rare.
Though it may be argued that cases of pulmonary involvement in secondary syphilis potentially are missed because radiography is not routinely performed, evidence points to the contrary. In a study conducted at Bellevue hospital between the years 1939 and 1944, 1,500 patients with secondary syphilis were screened for pathologic findings in the chest prior to arsenic treatment; none of these patients showed radiographic evidence of pulmonary involvement (S. Landry, quoted in Biro et al).

Given the extreme rarity of pulmonary involvement in secondary syphilis, Coleman et al proposed diagnostic criteria for this condition in 1983. These criteria include the following: (1) historical and physical findings typical of secondary syphilis; (2) serologic test results positive for syphilis; (3) pulmonary abnormalities seen radiographically with or without associated pulmonary symptoms or signs; (4) exclusion of other forms of pulmonary disease when possible by findings of serologic tests, sputum smears and cultures, and sputum cytology examination; and (5) therapeutic response of radiologic findings to antisyphilitic therapy.
To our knowledge, only seven cases have been previously reported that meet the Coleman criteria established above. In 1983, Coleman et al reported a case of secondary syphilis with a definite lingular and probable right lower lobe infiltrate (this patient most likely was infected with HIV, although the etiologic agent had not been discovered at the time of this case report); in 1994, Dooley and Tomski described an HIV-seropositive patient with bilateral basilar reticulonodular infiltrates. Four cases of solitary pulmonary nodules during secondary syphilis have been reported. In 1968, Biro et al described a case of secondary syphilis with multiple nodular lesions at the bases of both lungs.