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[À§¸Åµ¶. Gastric syphilis] - ðû
1. À§¸Åµ¶ÀÇ ÀÓ»óÀû Ư¡ Clinical features of gastric syphilis
2. À§¸Åµ¶ÀÇ ³»½Ã°æ ¼Ò°ß Endoscopic findings of gastric syphilis
3. CPC case
4. More cases
6. References
ÃÖ±Ù À§¸Åµ¶(gastric syphilis)ÀÌ Á¶±Ý¾¿ Áõ°¡ÇÏ´Â °Í °°´Ù´Â ÀǰßÀÔ´Ï´Ù. ÀüüÀûÀ¸·Î ¸Åµ¶ÀÌ Áõ°¡Çϰí ÀÖÀ¸¹Ç·Î À§¸Åµ¶µµ µû¶ó¼ Áõ°¡ÇÏ´Â °Í ¾Æ´Ò±î ½Í½À´Ï´Ù. ¿ì¸®³ª¶ó¿¡¼ ¸Åµ¶ ȯÀÚ´Â »ý°¢º¸´Ù ¸¹½À´Ï´Ù. 2008³âÀÇ °æ¿ì 1,548¸íÀ̾ú´Ù°í ÇÕ´Ï´Ù (Clin Endosc 2015;48:256). AIDS·Î ÀÎÇØ ´Ù¸¥ ¼ºº´ÀÌ ¹«½ÃµÇ°í Àֱ⠶§¹®ÀÎ °ÍÀ¸·Î ÃßÁ¤µË´Ï´Ù.
Gastric syphilisÀÇ Æ¯Â¡À» Á¤¸®ÇÏ¸é ¾Æ·¡¿Í °°½À´Ï´Ù.
1. Secondary and tertiary stage
2. Incidence in syphilis; <1%
3. Endoscopy; erosive gastritis or gastric ulcer with heaped, nodular edges or thickened, edematous rugal folds.
4. Histopathologic findings; suggestive, but not diagnostic
Á¦°¡ Áö±Ý±îÁö ¾Ë°í ÀÖ´Â gastric syphilis 6¿¹ÀÇ »çÁøÀÔ´Ï´Ù. ƯÈ÷ ù¹øÂ° Áõ·Ê´Â º¸¸¸ 4Çü ÁøÇ༺ À§¾Ï°ú ºñ½ÁÇÏ´Ù°í ÀǷڵǾú´ø °æ¿ìÀÔ´Ï´Ù.
2020-2-1. ºÎ»ê°æ³²Áöȸ ½ÉÆ÷Áö¾ö. ÁÁÀº»ï¼ºº´¿ø ÀÌÅ¿µ
History: A 25-year-old, apparently healthy man presented with one month history of epigastric tenderness and vomiting. The patient visited a local clinic where he underwent an endoscopic examination and the endoscopic diagnosis was benign gastric ulcer. But gastric ulcer symptom was not improved on ulcer medication. He was transferred to our hospital for further evaluation. His family history and past medical history were negative for any gastrointestinal disease, abdominal surgery or significant medical illness. Physical examinations were normal except minimal epigastric tenderness only. A laboratory evaluation revealed hemoglobin of 16.4 g/dL and hematocrit 47.9%. White blood cell count and differential count were within normal ranges. Total serum protein level was 7.3 g/dL and albumin level 4.3 g/dL. Serum bilirubin and liver enzymes were within normal ranges. A computed tomographic scan of the abdomen with contrast revealed diffuse layered thickening of the wall of the gastric antrum, pylorus, duodenal bulb, and second portion of duodenal loop without definite perigastric and periduodenal fatty infiltration (Fig. 1). Multiple small and enlarged lymph nodes were identified along both common femoral vessel and inguinal area. Gastric endoscopy showed geographic irregular ulcer and shallow depressed mucosal lesions in almost all aspect of the antrum. The ulcer revealed an irregular edge and uneven nodular base (Fig. 2). Endoscope was failed to advance to the duodenal bulb due to luminal obstruction. A diagnostic procedure was done.
Biopsy: Chronic gastritis, active, with intestinal metaplasia (incomplete type), large lymphoid follicle and dense lymphoplasma cell infiltration ( Note: Based on histology, syphilitic gastritis could be considered)
Layered wall thickening involving gastric antrum, pylorus, duodenal bulb,and 2nd duodenal loop
Automated Quantitative RPR Test: Reactive(5.00)
Automated Quantitative TPLA Test: Reactive(282.9)
A: foveolar pit ¿¡¼ H.pylori °¡ °üÂûµÇÁö ¾Ê´Â´Ù. B: ½ÉÇÑ À§¿°¼Ò°ßÀ¸·Î neutrophilic infiltration ÀÌ °üÂûµÈ´Ù. C: lamina propria ¿¡ ½ÉÇÑ lymphoplasma cell infiltration ÀÌ °üÂûµÈ´Ù. D: lagre irregular lymphoid follicular hyperplasia with geographic feature
Large irregular lymphoid follicle : H.pylori °¨¿°°ú´Â ´Þ¸® marginal zone Àº »ó´ëÀûÀ¸·Î À§ÃàµÇ¾î ÀÖÀ¸³ª follicular center °¡ ½ÉÇÏ°Ô ´Ã¾î³ª¸é¼ Áöµµ¸ð¾ç(geographic feature) À¸·Î Ä¿Á®ÀÖ´Ù.
CPC¿¡¼ ³íÀǵǾú´ø ÀÌ È¯ÀÚ´Â Áõ·Êº¸°í¸¦ ÇÏ¿´½À´Ï´Ù (À§¿Í ½ÊÀÌÁöÀåÀ» ħ¹üÇÑ ¸Åµ¶ 1¿¹).
4. More cases of gastric syphilis
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½ÅÁõÈıºÀ» µ¿¹ÝÇÑ À§¸Åµ¶ (Clin Endosc 2015). Gastroscopic findings. Multiple irregular, shallow ulcers covered with whitish exudates and central depression in the (A) antrum, (B) body, and (C) cardia. Histologic findings of gastric biopsy. (A) Marked severe inflammation with lymphoplasmacytic infiltrates (H&E stain, ¡¿400). (B) Numerous spirochetes are present between foveolar epithelial cells (Warthin-Starry stain, ¡¿1,000).
Á¦82ȸ ³»½Ã°æÇÐȸ Áý´ãȸ Áõ·Ê (2008)
41¼¼ ·¯½Ã¾Æ ±¹Àû ³²¼ºÀÇ ´ëÀå³»½Ã°æ¿¡¼ ¹ß°ßµÈ Á÷Àå ¸Åµ¶ Áõ·Ê¸¦ ¼Ò°³ÇÕ´Ï´Ù (Korean J Gastroenterol 2016).
³í¹®¿¡ ¾ð±ÞµÈ º´·Â°ú °Ë»ç ¼Ò°ßÀ» ¿Å±é´Ï´Ù.
"³»¿ø ÇÑ ´Þ Àü Ç×¹® ¼º±³¸¦ ÇÑ °æÇèÀÌ ÀÖ¾úÀ¸¸ç ³»¿ø 2ÁÖ Àü¿¡ Ç×¹® ÁÖº¯¿¡ ÅëÁõÀÌ ÀÖ¾ú´Ù°í ÇÏ¿´´Ù. Á÷Àå ³» ±Ë¾ç º´º¯¿¡ ´ëÇÑ °¨º° Áø´ÜÀ» À§ÇØ Ãß°¡ °Ë»ç¸¦ ½ÃÇàÇÏ¿´À¸¸ç Ç÷û ¸Åµ¶±Õ ƯÀÌÇ×ü(syphilis specific Ab) °Ë»ç¿¡¼ ¾ç¼º, ºñÆ®·¹Æ÷³×¸¶ °Ë»ç(nontreponemal test) °á°ú ¹ÝÀÀ¼º ¼Ò°ßÀÌ °üÂûµÇ¾ú´Ù. Àΰ£¸é¿ª°áÇ̹ÙÀÌ·¯½º(human immunodeficiency virus) Ç×ü ¹× Ç׿ø °Ë»ç´Â ¸ðµÎ À½¼ºÀ̾ú´Ù. Ç×¹®¿¬ »ó¹æ ºÎÀ§ÀÇ ±Ë¾ç º´º¯¿¡¼ ½ÃÇàÇÑ Á¶Á÷°Ë»ç °á°ú´Â ±Ë¾ç°ú À°¾ÆÁ¶Á÷À» µ¿¹ÝÇÑ Á÷Àå¿° ¼Ò°ßÀ̾úÀ¸¸ç(Fig. 3), Ãß°¡·Î ½ÃÇàÇÑ Warthin-Starry ¿°»ö¿¡¼ ½ºÇÇ·ÎÇìŸ(Spirochaete) ¼Ò°ßÀÌ °üÂûµÇ¾î ¸Åµ¶À¸·Î Áø´ÜÇÒ ¼ö ÀÖ¾ú´Ù(Fig. 3B). ȯÀÚ´Â ¸Åµ¶ Ä¡·á¸¦ À§ÇØ doxycycline º¹¿ëÀ» ½ÃÀÛÇÏ¿´À¸¸ç ÃßÀû °üÂûÀº ¿¬°íÁö º´¿ø¿¡¼ ½ÃÇàÇϱâ·Î ÇÏ¿´´Ù."
1) Gastric syphilis: a systematic review of published cases of the last 50 years. Sex Transm Dis 2010
The authors conducted a systematic review of the English literature for cases of Gastric Syphilis (GS) in the last 50 years. The 34 studies which met selection criteria included 52 patients with GS. Of the reviewed patients, only 13% had a history of syphilis diagnosis and 46% had prior or concurrent clinical manifestations of the disease. Epigastric pain/fullness was the most common presenting symptom (92%) and epigastric tenderness being the most common sign. Gastric bleeding of variable intensity was documented in 35% of the cases. In the radiologic examinations, fibrotic narrowing and rigidity of the gastric wall was the most common finding (43%), followed by hypertrophic and irregular folds, while in endoscopy the most common lesion types were multiple ulcerations (48%), nodular mucosa, and erosions. The antrum was the most commonly affected area (56%). The majority of the patients received penicillin (83%) with a rapid resolution of their symptoms. Seventeen percent of the patients were treated surgically either due to a complication or due to strong suspicion of infiltrating tumor or lymphoma. The nonspecific clinical, radiologic, and pathologic characteristics of GS can establish it as a great imitator of other gastric diseases. GS should be considered in the differential diagnosis in patients at risk for sexually transmitted diseases who present with abdominal complaints and unusual endoscopic lesions and no other diagnosis is made, irrespective of the presence of H. pylori. The absence of primary or secondary luetic lesions should not deter one from considering GS.
2) Syphilis: A Review JAMA 2025
Importance: Syphilis is an infectious disease caused by Treponema pallidum, a gram-negative, spirochete bacterium. Worldwide, an estimated 8 million adults aged 18 to 49 years acquired syphilis in 2022. From 2019 to 2023, US syphilis cases increased by 61% overall, with diagnoses among females increasing by 112% and congenital syphilis cases increasing by 106%.
Observations: Syphilis is transmitted via contact with infectious lesions during vaginal, anal, or oral sex or via the placenta during pregnancy. Individuals at increased risk for syphilis include people with HIV, those engaging in condomless sex with multiple partners, and men who have sex with men (MSM)-who comprised one-third (32.7%) of all males with primary and secondary syphilis in 2023. Early syphilis is defined as syphilis in the first year after infection and includes symptomatic (primary and secondary) and asymptomatic (early latent) stages. Primary syphilis is characterized by painless anogenital lesions. Secondary syphilis is associated with a diffuse rash, mucocutaneous lesions, and lymphadenopathy. Syphilis diagnosed more than a year after infection is referred to as late syphilis and includes asymptomatic (late latent) and symptomatic (tertiary) stages. Neurosyphilis, which can occur at any stage, can lead to meningitis, uveitis, hearing loss, or stroke. In pregnancy, up to 40% of fetuses with in-utero exposure to syphilis are stillborn or die from their infection during infancy. The diagnosis of syphilis relies on serologic reactivity along with a clinical history and presentation consistent with active or latent syphilis infection. The recommended treatment for syphilis is benzathine penicillin G administered as intramuscular doses of 2.4 million units: a single injection for early stage and 3 weekly injections for late latent stage syphilis. Strategies to identify and prevent syphilis infections include (1) screening of sexually active people aged 15 to 44 years at least once and at least annually for those at increased risk, (2) screening 3 times in pregnant individuals (at the first prenatal visit, during the third trimester, and at delivery), (3) counseling about condom use, and (4) offering doxycycline postexposure prophylaxis (200-mg doxycycline taken within 72 hours after sex as postexposure prophylaxis) to MSM and transgender women with a history of a sexually transmitted infection in the past year.
Conclusions and relevance: Syphilis infections, including congenital syphilis, have increased in the US and worldwide over the past decade. First-line treatment for syphilis is benzathine penicillin G. Routine syphilis screening of all pregnant patients and all sexually active people aged 15 to 44 years and use of doxycycline postexposure prophylaxis in individuals at risk for syphilis infection are recommended strategies to decrease syphilis transmission.3) [¿¬ÇÕ´º½º] ±¹³»¼ ´Ã¾î³ '¸Åµ¶'¡¦Áõ»ó°ú Ä¡·á¹ýÀº?
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© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.