Diagnosing syphilis can be particularly challenging, especially when patients might withhold critical information. In Belgium, an intriguing case surfaced when doctors encountered an 83-year-old married man diagnosed with a rare form of secondary syphilis, the second of the four stages of this elusive sexually transmitted bacterial infection.
The patient, who boasted of a 50-year monogamous marriage, mentioned that he had been sexually inactive for several years due to cancer treatment. In a Clinical Problem-Solving report from the New England Journal of Medicine, doctors detailed the intricate tests and logical processing they employed to reach their final diagnosis, which still left some questions unanswered.
The situation unfolded when the elderly man visited an emergency department, struggling with severe itchiness. A month earlier, specialists had seen him for facial paralysis, noting elevated liver enzymes in his blood. They initially suspected a viral infection but ruled out several possibilities, including HIV, Epstein-Barr, cytomegalovirus, and hepatitis variants A, B, C, and E.
Although the facial paralysis resolved with steroid treatment, his liver function abnormalities lingered. By the time he visited the emergency department, additional symptoms had developed, including joint pain in his knees and ankles, general malaise, loss of appetite, and swelling in various parts of his body such as his feet, legs, face, arms, and hands.