Clinical and pathological features of gastric syphilis in a young woman: A case and literature review
5 affiliations
- 1Department of Pathology, People's Hospital of Xinjiang Uygur Autonomous Region, Tianshan District, No. 91, Tianchi Road, Urumqi, Xinjiang, 830001, China
- 2Department of General Surgery, Gastrointestinal Center, People's Hospital of Xinjiang Uygur Autonomous Region, Tianshan District, No. 91, Tianchi Road, Urumqi, Xinjiang, 830001, China
- 3Department of Pathology, The Sixth People’s Hospital of Xinjiang Uygur Autonomous Region, New Urban District, No. 100, Kashi East Road, North Lane 1, Urumqi, Xinjiang, 830001, China
- 4Department of Pathology, People's Hospital of Pishan County, East Jingsan Road, Pishan County, Hotan, Xinjiang, 845150, China
- 5Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Key Laboratory of Digestive Diseases of Anhui Province, Shushan District, No. 218, Jixi Road, Hefei, Anhui Province, 230022, China
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.
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BibTeX
@article{han2026clinical,
title = {{Clinical and pathological features of gastric syphilis in a young woman: A case and literature review}},
author = {Wen Han and Qian Zhang and Hongwei Ye and Jin Ma and Chun Wang and Hailiqiemu Maimaiti and Lihong Chen and Yuhuan Wang and Xinlan Song},
journal = {IDCases},
year = {2026},
month = oct,
doi = {10.1016/j.idcr.2026.e02800},
url = {https://doi.org/10.1016/j.idcr.2026.e02800},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Clinical and pathological features of gastric syphilis in a young woman: A case and literature review
AU - Wen Han
AU - Qian Zhang
AU - Hongwei Ye
AU - Jin Ma
AU - Chun Wang
AU - Hailiqiemu Maimaiti
AU - Lihong Chen
AU - Yuhuan Wang
AU - Xinlan Song
PY - 2026
DA - 2026/10/24
JO - IDCases
DO - 10.1016/j.idcr.2026.e02800
UR - https://doi.org/10.1016/j.idcr.2026.e02800
AB - 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.
SN - 2214-2509
ER -