Diagnosing syphilis, a disease renowned for its ability to mimic other conditions, can be particularly challenging, especially if a patient is not providing complete information. This complexity was highlighted in Belgium, where a team of doctors encountered an intriguing case involving an 83-year-old man diagnosed with an uncommon form of secondary syphilis—the second phase in the progressive stages of the sexually transmitted bacterial infection known for being a 'master of disguise.'
The patient, describing himself as in a monogamous marriage of 50 years and sexually inactive after cancer treatment, left doctors with many unanswered questions even after they identified the correct diagnosis. Details of this intricate case were documented in a Clinical Problem-Solving report published in the New England Journal of Medicine.
The situation unfolded when the elderly man arrived at the emergency department with a primary complaint of severe itching. A month prior, the patient had experienced facial paralysis, at which time doctors had also detected elevated liver enzymes. Initial assessments led doctors to suspect a viral infection, yet extensive testing for various viruses, including HIV, Epstein-Barr, cytomegalovirus, and Hepatitis A, B, C, and E, yielded negative results.
Although the facial paralysis resolved following steroid treatment, the anomaly of persistent abnormal liver test results remained. By the time of his emergency department visit, the patient also displayed additional symptoms, including joint pain in the knees and ankles, general malaise, a lack of appetite, and sporadic swelling affecting his feet, legs, as well as sometimes his face, arms, and hands.