Emergence of forgotten entities.

Sir,

Cases of syphilis are encountered in all centers.[1] Late syphilitic manifestations of cardiovascular system and central nervous system (CNS) can occur with these cases.[23] Late complications of lymphogranuloma venereum (LGV) and Granuloma inguinale cases would be likely to persist in spite of all treatments. Few cases of precocious tertiary syphilitic CNS cases were reported in the presence of AIDS.[45]

In the last 1 year duration, I had 3 cases of late syphilitic manifestations and one case of LGV with genital elephantiasis (esthiomene) in the absence of HIV infection. Coronary ostial stenosis went unnoticed even during 1980s. However, present day advances in the modalities of investigations made it easy to clinch such diagnosis. This type of diagnosis will avoid unnecessary surgeries for ischemia which are done widely nowadays. Without medical treatment, these surgeries would be likely to end up in failure.

A 72-year-old man came to cardiology department with the complaints of breathlessness. On investigation, he was found to have reactive serology for syphilis and referred to our department. He is married and gave a history of promiscuity and genital ulcer before marriage. His venereal disease research laboratory and Treponema pallidum hemagglutination assay (TPHA) were reactive in 32 dilutions and 160 dilutions respectively and nonreactive for HIV. Blood investigations were within normal limits. Angiogram revealed triple vessel disease along with ostial stenosis. This patient was treated with anti-syphilitic treatment. Patient is doing well with medical management for the past 6 months without any problem

A 62–year-old male came with defective vision. Cataract surgery was planned. Preoperative investigations revealed reactive for syphilis and nonreactive for HIV. X-ray chest revealed a mediastinal mass [Figure 1]. On examination, patient gave a history of premarital sex and sore genitals. He has two wives, and history of abortion was present with the first wife whereas no issue for the second wife. His rapid plasma reagin (RPR) and TPHA were reactive in 32 dilutions and 2560 dilutions respectively and nonreactive for HIV. A saccular aneurysm arising from the arch of aorta with partial thrombosis occupied the aneurysmal sac revealed by C. T Thorax. This patient lost for follow-up

Figure 1

Chest X-ray: Aneurysm of arch of aorta

A 44-year-old married man came with the complaints of the progressive dimness of vision and photophobia on his left eye. As he was reactive for syphilis, referred for the management of syphilis. He gave a history of both pre- and extra-marital sex without the previous venereal disease. He was a diabetic for more than 5 years. His RPR and TPHA were reactive in 16 dilutions and 160 dilutions, respectively. Other blood parameters were within normal limits. He was treated with anti-syphilitic treatment as for late latent syphilis under cover of steroids

A 65-year-old man with bilateral swelling of scrotum and inguinal region for more than a year. The patient was sexually active and had inguinal swelling for which he had an incision and drainage 20 years back. On examination, he had an elephantiatic swelling of scrotum [Figure 2]. Epididymis and testes were free. Penis was edematous looked like a saxophone [Figure 2]. Left inguinal area nodes were matted and little hard. The skin over the inguinal glands was edematous ('Pu De Orange') [Figure 3]. Blood parameters were within normal limits including the serum proteins and A-G ratio. He was nonreactive for HIV. His swelling of scrotum and penis were not responding to antibiotics such as Doxycyclin, Co-Trimaxazole, Azithromycin, and steroids. The patient was not willing for surgical correction. Patient's clinical picture fits with genital syndrome of LGV.

Figure 2

Scrotal elephantiasis

Figure 3

Lymphedema of skin

Complications of old untreated diseases can be presented at any time. A high index of suspicion is necessary to recognize the same. Advanced technology can pick up forgotten entities.

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Conflicts of interest

There are no conflicts of interest.