The 44-year-old has been suffering from abdominal pain for a month when she introduces herself to a clinic in the US city of Philadelphia. Before this symptom, she had a fever, sore throat, body aches for a week. In addition, it has a rash that extends to the palms.
The doctors administer her an antibiotic, as reported in the "ACG Case Reports Journal". But the abdominal pain only gets worse, the woman is sick, she hardly likes to eat. A blood test shows abnormal liver values. In an abdominal ultrasound, lymph nodes near the liver and pancreas appear swollen. A magnetic resonance tomography of the abdominal cavity brings no further insights.
Stomach paralyzed, liver inflamed
Another test shows that the gastric emptying is disturbed in the patient, it has a so-called gastric paralysis. In addition, the doctors discover inflamed areas in the lower part of the esophagus. However, the woman does not have gastric inflammation caused by the bacterium Helicobacter pylori - as in these cases frequently. A test for the pathogen is negative. Doctors can also exclude hepatitis B, HIV and certain autoimmune diseases through appropriate studies.
However, her liver is inflamed, and bile accumulates in the organ. Parts of the liver are already scarred, the physicians determine in a liver biopsy.
The doctors suspect autoimmune hepatitis and prescribe a drug that suppresses the immune system. In addition, she receives a drug for the inflammation of the bile ducts. But both bring no improvement.
Chest pain, fever, swollen lymph nodes
Another clinic, another case: A 26-year-old seeks medical help for persistent dry cough, chest pain and fever. He explains to the doctors in Recife, Brazil, that he lost ten kilos last year without wanting to. The doctors feel several swollen lymph nodes - including in the left armpit and the groin, they report in the "Revista da Sociedade Brasileira de Medicina Tropical".
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In a blood test, the cell count is normal, the liver values are okay, and the kidneys seem to work well. A computed tomography confirms the swelling of several lymph nodes. This could be due to a tumor. To clarify this, the doctors take the swollen knot from the left armpit. More detailed studies of the tissue show that it is not a tumor.
The doctors now test the man for various infectious diseases: HIV, toxoplasmosis, hepatitis viruses, cytomegaloviruses. Everything is negative.
The saving diagnosis
Until they test the patient for syphilis. In fact, they detect the syphilis pathogen Treponema pallidum. The doctors inject the man now an antibiotic for several weeks. Two months later he recovered. The lymph nodes have shrunk back to normal size.
The 44-year-old patient in the US receives the diagnosis two weeks after her liver biopsy when she visits a gynecologist for vaginal complaints. Again, a now performed test shows Treponema pallidum. After several weeks of antibiotic treatment, the abdominal pain disappear, liver values of the woman return to normal levels. The first dose of antibiotics in the hospital was obviously not enough to kill the pathogens.
The disease is in several stages
Syphilis is usually transmitted during sex, the disease is in several stages. The first symptoms usually appear two to three weeks later and may be quite unremarkable - a non-painful ulcer forms on the mouth or on the genitals, which heals by itself. In addition, lymph nodes can swell.
Four to ten weeks after infection, patients may experience fever and headache, joint or muscle pain, writes the Robert Koch Institute. Most of the sufferers get a rash, and it form flat nodules in skin folds. Again, this often goes by without treatment by itself.
In the third stage, which can occur without treatment several years after the infection, the pathogen in the worst case harms vessels and internal organs. Possible consequences include psychosis or dementia.
Syphilis can be treated with antibiotics, especially penicillin.