Syphilis can be a tricky disease to diagnose—especially when a patient may not be sharing the whole story.
Doctors in Belgium met with a real head-scratcher when an 83-year-old married man came in with a rare form of secondary syphilis—the second of four stages of the sexually transmitted bacterial infection that has been called a “master of disguise.”
The man told doctors up front that he was in a monogamous 50-year-long marriage and had been sexually inactive in recent years following treatment for cancer. In a Clinical Problem-Solving report published today in the New England Journal of Medicine, doctors laid out the step-by-step tests and reasoning they used to get to the right diagnosis, which still didn’t answer all their questions.
The case began when the elderly man showed up at an emergency department complaining of severe itchiness. They noted that a month prior, he had been seen by specialists for paralysis on one side of his face. At that time, doctors found that liver enzymes in his blood were also elevated. They assumed it was all caused by a viral infection, but he had tested negative for a variety of them, including HIV, Epstein-Barr, cytomegalovirus, and Hepatitis A, B, C, and E.
The paralysis eventually cleared up with a steroid treatment, but the abnormal liver tests persisted. By the time he wound up in the emergency department, he had also developed joint pain in his knees and ankles, malaise, loss of appetite, and swelling in his feet, legs, and occasionally in his face, arms, and hands.