A 36 year-old man presented with complaints of nausea of two months duration, 3-4 weeks of burning upper abdominal pain, and several days of protracted vomiting with intermittent hematemesis (vomiting of blood). He had no prior history of gastrointestinal disease, and denied use of aspirin, ibuprofen-like agents or other gastrointestinal irritants. During his illness he had lost 17 lbs.
Upper endoscopy demonstrated a 2.5 cm ulcer in the proximal gastric body (left), numerous stellate and serpiginous ulcers involving the gastric antrum extending into the pyloric channel (center), and an inflamed, cobblestone appearance of the duodenum with superficial ulcerations (right).
Because of the unusual set of endoscopic findings, an RPR was obtained and was positive at 1:512; FTA was likewise positive. Cerebral spinal fluid VDRL was negative. Gastric and duodenal biopsies revealed both Helicobacter pylori and spirochetes (Treponema pallidum).
50 year-old undergoing screening colonoscopy for a personal history of colon polyps as well as a family history of colon polyps. No polyps were found, but inflammation was noted in the rectum, with multiple punctate submucosal hemorrhages involving the distal 4 cm of rectum. Biopsies were indicative of luetic (syphilitic) proctitis, confirmed by silver stains which revealed spirochetosis.
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