Rectal syphilis presenting as a bleeding rectal tumour

Rectal bleeding is a very common symptom referred to hospitals for proctoscopy daily. We present a rare case of a bleeding mass in the rectum. A male patient in his 40s was referred to hospital due to rectal bleeding. On the digital rectal examination, a polypus rectal mass was palpated. Biopsies were taken, and the magnetic resonance imaging (MRI) described a 5 cm long tumour. Multiple enlarged lymph nodes in the area were seen on MRI also outside the mesorectum with possible venous infiltration. Radiologically, it was categorized as T3bN2. Due to the patient history, a test for syphilis was requested, which confirmed the diagnosis. Hence, the rectal tumour was identified as a primary chancre of syphilis. Rectal syphilis is a rare manifestation of syphilis, but must be kept in mind as a differential diagnosis when encountering a bleeding rectal mass, especially in men having sex with men.