Description
A 55-year-old woman presented to the hospital with vomiting and epigastric pain for 3 weeks and coffee-ground vomitus for 1 day. She reported 6 kg of weight loss over a 1-month period. The patient had been sexually active with the same male partner for the past 20 years but reported her partner to be promiscuous. Physical examination was remarkable for epigastric tenderness. CT of the abdomen showed mural thickening of the stomach (figure 1). Upper endoscopy showed erythema and friable mucosa with nodularity (figure 2).Multiple biopsies revealed gastric syphilis with interstitial metaplasia, and immunostaining showed numerous Treponema pallidum (figures 3 and 4). Rapid plasma reagin (RPR) titre was 1:128 (normal: non-reactive). The patient received one dose of intramuscular penicillin G 2.4 million units and reported full resolution of her symptoms on 3 months' follow-up. Repeat RPR titre 3 months after treatment was 1:32, repeat upper endoscopy at the...
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