Secondary Syphilis with Pleural Effusion: Case Report and Literature Review

Here we present a case of a 38-year-old Indian man with a history of extramarital relationships who presented with pleurisy, skin rash, and radiological findings of pleural effusion. After thorough investigation of the etiology of his acute illness, he was found to be positive for syphilis. Review of literature revealed a small number of case reports of pleural effusion as a manifestation of secondary syphilis. The review of criteria proposed in the literature was utilized to diagnose this patient as a case of pulmonary syphilis. 1. Introduction Syphilis is a sexually transmitted illness caused by the organism Treponema pallidum. The infection itself is acquired mainly via sexual contact with clinical manifestations such as a chancre or skin rash. However, although less common, the infection can also be contracted by nonsexual contact, organ transplantation, blood transfusion, or in utero infection [1]. With the introduction of penicillin therapy to counter syphilis infection, the number of cases in the developed countries such as United States has decreased by 95% since 1943 [1]. The natural course of syphilis begins with an inoculation period of 21 days on average, rarely exceeding 6 weeks. Syphilis can present itself in three different stages, specifically primary, secondary, and tertiary syphilis, with each stage characterized by unique clinical manifestations. Although uncommon, report of pulmonary illness in patients with proven syphilis exists in the literature. Only a handful of cases report such involvement, with variable presentations reported. Pulmonary syphilis occurred mainly in congenital and tertiary syphilis in the preantibiotic era, but, since 1967, it has been occurring mainly during secondary syphilis [2]. David and his coworkers [2] sited Coleman et al. [3] regarding the fact that lung involvement in patients with syphilis during the preantibiotic area ranged from 1% to 12.5%. Here we present a case of a patient with suspected pulmonary syphilis, with significant pleural effusion and clinical and diagnostic evidence of syphilis infection. Our case is consistent with the fact that most infections are now related to cases resembling secondary syphilis. We chose to incorporate the diagnostic criteria for pulmonary syphilis proposed by Coleman et al which was presented by David et al. [2]. 2. Case Report A 38 year-old Indian man presented with a past medical history significant for recurrent low-grade fevers and a new diagnosis of Diabetes Mellitus being treated with metformin. He complained of pain in the right chest and right upper