A Clinical Observation of Syphilitic Gastritis: Biopsy-proven Contagious Treponema Pallidum in the Gastric Mucosa Tohru Kajiyama 1 1Department of Gastroenterology, Tenri Hospital pp.1231-1236
Published Date 1986/11/25
DOI https://doi.org/10.11477/mf.1403110120
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 A case of a 35 year-old woman with epigastralgia and vomiting is presented. Although an upper gastrointestinal study initially raised suspicion of gastric cancer (Fig. 2 b), gastrofiberscopic examination disclosed numerous shallow erosions with marked friability (Fig. 3 a, b), and initial gastric biopsy showed intense mononuclear infiltration with no evidence of malignancy (Fig. 5a). Based on these findings, together with a positive result of a serologic test for syphilis, we strongly suspected the presence of syphilitic gastritis. Subsequently, many motile spirochetes were demonstrated in freshly obtained biopsy material washed in saline by phase-contrast microscopy (Fig. 5 b), with strongly positive specific treponemal immunofluorescence (Fig. 6 b). Several spirochetes were also identified with the Warthin-Starry silver stain (Fig. 6 a). To prove the syphilitic nature of this lesion, we inoculated a mouse with saline emulsion of a biopsy specimen. Several weeks later the mouse developed syphilitic orchitis (Fig. 7). The patient was treated with penicillin. Repeated gastroscopy performed after 90 days of therapy revealed complete recovery without scarring (Fig. 4 d).

 This is the first case of syphilitic gastritis reported in Japan where contagious T. pallidum was demonstrated from a gastroscopic biopsy specimen. Endoscopic examination with biopsy and appropriate tissue staining are essential for the diagnosis of syphilitic gastritis, and to the consequent avoidance of surgery.

Copyright © 1986, Igaku-Shoin Ltd. All rights reserved.


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