A case of syphilitic anal condylomata lata mimicking malignancy. (2015)

• Record Type: Journal Article
• Authors: Tayal, Sarup; Shaban, Fadlo; Dasgupta, Kaushik; Tabaqchali, Mohamed A.
• Is Part Of: International journal of surgery case reports. Volume 17(2015)
• Page Start: 69
• Page End: 71
• Publication Date: 2015
• Subjects: Condylomata lata -- Syphilis -- Malignancy -- Biopsy; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2015.10.035
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Condylomata lata are a cutaneous manifestation of secondary syphilis and can be misdiagnosed as condylomata acuminata (warts caused by human papillomavirus), anal cancer, chancroid, haemorrhoids, tuberculosis and lymphogranuloma venereum. Condylomata lata are flesh coloured or hypo pigmented, macerated papules or plaques. We present a case of a 49-years-old gentleman who initially presented to primary care with perianal pain and peri-anal skin changes who was referred to the colorectal clinic under the two-weeks rule with suspected anal cancer. The diagnosis was confirmed by biopsy and positive standard tests for syphilis. Once condylomata lata is suspected or diagnosed, refer promptly to sexual health clinic for further investigations, treatment, contact tracing and follow up. Early treatments with intramuscular benzathine benzylpenicillin prevent serious neurological and cardiac complication. Abstract: Introduction: Condylata lata in secondary syphilis is well known presentation and needs to be considered in differential diagnosis of perianal lesions. In England between 2013 and 2014 the overall incidence of infectious syphilis increased by 33% and is mainly seen in men who have sex with men. Presentation of case: We report the management of a 49-years-old Caucasian homosexual man with perianal lesions that were suspicious of malignancy. After biopsies, colonoscopy, staging with computed tomography, magnetic resonance imaging and syphilis serology anal cancer was excluded and a diagnosis of syphilis was confirmed. He was referred to the sexual health clinic for the appropriate investigations and treatment. Discussion: This case highlights the consideration of treatable infectious syphilis pathology. The main differential diagnosis of perianal growths to consider is condylomata acuminata (warts caused by human papillomavirus), anal cancer, syphilis, chancroid, haemorrhoids, tuberculosis and lymphogranuloma venereum. To differentiate a biopsy is needed for histopathological examination. A dense plasma cell infiltrate and numerous spirochetes visualised by immunostaining confirms condylomata lata. Conclusion: In UK, it is important for colorectal surgeons to be aware of syphilitic condylomata lata and consider this when dealing with perianal lesions. It is advisable to refer patients suspected of or diagnosed with syphilis to sexual health clinics to help improve outcome. In sexual health clinics additional investigations and treatment are available in addition to partner notification and follow-up can be offered.