Chest
Postgraduate Education CornerChest Imaging and Pathology for CliniciansA 40-Year-Old Man With a Nodular Lung Disease and Skin Rash
Section snippets
What is the diagnosis?
Diagnosis: Secondary syphilis with pulmonary involvement
Clinical Discussion
The differential diagnosis of multiple lung nodules in this patient can be limited to infectious and noninfectious etiologies. Fungal and mycobacterial infections as well as nocardia, and septic emboli were all excluded in the absence of positive cultures from bronchoscopies and biopsies as well as negative serological tests and echocardiography. Noninfectious etiologies such as rheumatoid nodules, and carcinoid, vasculitic lesions such as granulomatosis with polyangiitis (Wegener) and
Clinical Course
After missing several follow-up appointments, the patient returned to clinic for follow-up 6 months later. He reported that his skin lesions were getting worse despite two courses of antibiotics and steroid creams prescribed by his primary provider and urgent care centers. Skin biopsy was repeated and revealed superficial and deep plasma-rich perivascular infiltrate and nonnecrotizing granulomas in the superficial dermis, suggestive of syphilis, autoimmune vascular disease, or sarcoidosis (Fig 6
Conclusion
Syphilitic lung involvement is rare but should be suspected in highly endemic areas presenting with pulmonary nodules and skin rash, especially when work-up of pulmonary nodules returns negative for other infectious, malignancy, vasculitic illnesses, and sarcoidosis. Detailed history, serological tests for syphilis, and biopsies of skin and lung lesions may be needed to confirm the diagnosis.
Based on our observations in this case and review of the previously reported cases, in addition to
Acknowledgments
Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Other contributions: This case and all related work-up was done at Louisiana State University Health Sciences Center, Shreveport, LA.
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