Kalyan C. Mantripragada, MD, MPH; Sophia Fircanis Rizk, MD; John L. Reagan, MD; Mark LeGolvan, MD
This article was published at www.annals.org on 22 March 2016.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L15-0527.
Mantripragada K., Rizk S., Reagan J., LeGolvan M.; Acquired Syphilis With Anemia and Leukoerythroblastic Reaction: A Case Report. Ann Intern Med. 2016;165:226-227. doi: 10.7326/L15-0527
Download citation file:
Published: Ann Intern Med. 2016;165(3):226-227.
Published at www.annals.org on 22 March 2016
Background: The number of cases of syphilis reported to the Centers for Disease Control and Prevention increased by 13.1% between 2012 and 2013 (1).
Objective: To report an adult patient with acquired syphilis, extramedullary hematopoiesis, and involvement of the bone marrow and liver, which have been described previously only with congenital syphilis.
Case Report: A 65-year-man presented to our hospital with 6 weeks of increasing fatigue, 20-lb weight loss, and temperature of up to 100.8 °F. In addition to having hypertension and type 2 diabetes mellitus, he was receiving long-term HIV prophylaxis because of a serodiscordant relationship with an HIV-positive male partner. On initial testing, he had normocytic anemia with a hemoglobin level of 84 g/L (nadir 67 g/L); leukocyte count 6.9 × 109 cells/L; platelet count 161 × 109 cells/L, normal renal function; elevated total bilirubin levels (27.37 µmol/L [1.6 mg/dL]); and modestly elevated levels of alanine aminotransferase (68 IU/L), aspartate aminotransferase (99 IU/L), and alkaline phosphatase (379 IU/L). Extensive work-up for the source of his fever was done. HIV and viral hepatitis test results were negative. Blood and urine cultures were negative for bacteria, fungus, and mycobacteria. Transesophageal echocardiography did not find vegetations. Upper and lower endoscopy did not find any sources of blood loss. Computed tomography showed only changes consistent with cirrhosis and splenomegaly. Liver biopsy to evaluate new-onset cirrhosis and transaminitis showed chronic portal tract inflammation with bile duct damage and lymphocytic infiltration. Positron emission tomography revealed diffuse heterogeneous uptake in the bone marrow. Rapid plasma reagin titers were positive at 1:512, and confirmatory syphilis serology was positive using the fluorescent treponemal antibody absorption test along with the Treponema pallidum particle agglutination assay.
to gain full access to the content and tools.
Learn more about subscription options.
Register Now for a free account.
Hematology/Oncology, Infectious Disease, Red Cell Disorders, Sexually Transmitted Infections.
Results provided by:
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only