Tonsillar hypertrophy-associated false-positive syphilis serology in children: a clinical and immunologic analysis of...

Serologic testing for Treponema pallidum is the basis of diagnosis for syphilis. False-positive serologic results, however, may result in inaccurate diagnosis, with a substantial impact on clinical management and patient status.

This study reports 5 cases of children who presented with tonsillar hypertrophy and had false-positive results on the syphilis chemiluminescence immunoassay (CLIA).

The children tested positive for syphilis by CLIA but negative by enzyme-linked immunosorbent assay, rapid plasma reagin test, and T pallidum particle agglutination test. Laboratory examination revealed that all 5 children had abnormally high serum immunoglobulin G levels, suggesting that tonsillar hypertrophy-induced polyclonal B-cell activation can generate nonspecific antibodies that cross-react with the solid-phase antigen in the CLIA kit.

The current study is the first to identify the characteristic interference of chronic head and neck inflammation in children by CLIA testing. It suggests that for similar cases, the test result should be verified by various methods after a preliminary positive screening, and the patient's immune activation status should be monitored to distinguish nonspecific interference.