Syphilis mimicking a metastatic tumour: a case report and review of the literature
By
Tobias R. Dashi
Sebastian Boeltz
Kristina Schilling
Olaf Conrad
Shahed Shafaei
Eva L. Balbach
Franziska Schmid
Barbara Nuebel
Abbas Agaimy
Jochen Wacker
Giuseppe Valenza
Georg Schett
Thomas Harrer
May 6, 2026
Clinical Scorecard: Syphilis Presenting as a Metastatic Tumor: A Case Study and Literature Review
At a Glance
Category Detail
Condition Tertiary Syphilis Key Mechanisms Caused by Treponema pallidum, leading to granulomatous lesions and potential metastatic mimicking. Target Population Adults, particularly those with a history of untreated syphilis. Care Setting Hospital-based evaluation and multidisciplinary tumor board review.
Key Highlights
Tertiary syphilis can present as pseudotumorous lesions, mimicking malignancy. A 57-year-old man exhibited cervical lymphadenopathy and significant weight loss. Histopathological analysis confirmed necrosis and inflammatory infiltrates consistent with tertiary syphilis. Serological testing revealed high antibody titers for Treponema pallidum. Empiric treatment with ceftriaxone was initiated pending definitive diagnosis. Guideline-Based Recommendations
Diagnosis
Consider syphilis in differential diagnosis for patients with unexplained lymphadenopathy and systemic symptoms. Utilize serological testing for Treponema pallidum. Management
Initiate treatment with appropriate antibiotics such as ceftriaxone for suspected neurosyphilis. Monitoring & Follow-up
Regular follow-up serological testing to assess treatment response. Risks
Untreated syphilis can lead to severe complications including cardiovascular and neurological manifestations. Patient & Prescribing Data
Adults with a history of syphilis or presenting with atypical symptoms.
Empiric treatment should be considered in cases with high suspicion of syphilis.
Clinical Best Practices
Incorporate syphilis screening in patients presenting with unexplained systemic symptoms. Ensure multidisciplinary evaluation for complex cases presenting as tumors. References
