Syphilitic gumma arising in association with foreign material

Area of Science:

• Infectious Diseases
• Dermatology
• Pathology

Background:

• Syphilis incidence is increasing after a period of decline.
• Tertiary syphilis, particularly cutaneous forms, is rare and diagnostically challenging.
• Standard serological tests like rapid plasma reagin can be negative in tertiary syphilis.

Observation:

• Histologically, late-stage cutaneous syphilis manifests as noduloulcerative or gummatous lesions.
• Traditional spirochete stains (e.g., silver stains) are often negative in these lesions.
• Immunohistochemical stains are also frequently unrevealing due to low organism burden.

Findings:

• Presents a rare case of gummatous tertiary syphilis.
• The syphilis manifestation was associated with foreign material.
• The foreign material was deposited following a motor vehicle accident.

Implications:

• This case underscores the diagnostic difficulties in tertiary syphilis, especially with atypical presentations.
• It highlights the importance of considering syphilis in patients with unexplained cutaneous lesions, even with negative serology.
• The association with foreign material suggests potential co-factors in disease manifestation or presentation.