PANCYTOPENIA: A RARE PRESENTATION OF SYPHILIS

Main Article Content

Aliena Badshah
Syed Osama Husain
Zoia Ehsan Khattak

Abstract

INTRODUCTION: Syphilis is caused by spirochete Treponema pallidum. A common mode of transmission is via sexual contact and mainly targeting high-risk populations such as those with Human Immunodeficiency Virus and men who have sex with men (MSM). It has a wide range of presentations based on the four main overlapping clinical stages. Due to the lack of vaccines to prevent syphilis, prompt diagnosis and management of infected persons are warranted to reduce disease burden and its clinical effects. 


CASE PRESENTATION: We present an unorthodox case of pancytopenia in a 55-year-old male patient who developed chronic progressive weakness, generalized body aches, and intermittent fever. His blood tests revealed pancytopenia and bone marrow biopsy revealed caseous necrosis. Since the patient had a positive history of MSM, syphilis serology was sent, which turned out to be positive. The patient responded to intravenous benzylpenicillin and oral doxycycline.


CONCLUSION: Of note, not every pancytopenia in the elderly is due to malignancy, bone marrow aplasia or acute viral / parasitic insult; other uncommon causes also exist. Syphilis should be kept among the differentials of pancytopenia when more common causes have been excluded. A good sexual history is pertinent to reaching the correct diagnosis in such cases.

Article Details

How to Cite
Badshah, A., S. Husain, and Z. Khattak. “PANCYTOPENIA: A RARE PRESENTATION OF SYPHILIS”. KHYBER MEDICAL UNIVERSITY JOURNAL, Vol. 13, no. 3, Sept. 2021, pp. 170-2, doi:10.35845/kmuj.2021.20661.
Section
Case Report

References

1. Cohen SE, Klausner JD, Engelman J, Philip S. Syphilis in the modern era: an update for physicians. Infec Dis Clin 2013;27(4):705-22. http://dx.doi.org/10.1016/j.idc.2013.08.005.
2. Janier Á, Hegyi V, Dupin N, Unemo M, Tiplica G, Potočnik M, et al. 2014 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol 2014;28(12):1581-93. https://doi.org/10.1111/jdv.12734.
3. Stamm LV. Syphilis: Re-emergence of an old foe. Microb Cell 2016;3(9):363. https://doi.org/10.15698/mic2016.09.523.
4. Salem K, Majeed H, Bommireddy R, Klezl Z. Tertiary syphilis in the cervical spine: a case report and review of the literature. Global Spine J 2013;3(1):041-6. http://dx.doi.org/10.1055/s-0032-1329887.
5. Clement ME, Okeke NL, Hicks CB. Treatment of syphilis: a systematic review. JAMA 2014;312(18):1905-17. https://doi.org/10.1001/jama.2014.13259.
6. Mantripragada KC, Fircanis S, Reagan JL, LeGolvan M. Acquired Syphilis With Anemia and Leukoerythroblastic Reaction: A Case Report. Ann Intern Med 2016;165(3):226-7. https:// doi.org/10.7326/L15-0527.
7. World Health Organization. Sexually transmitted infections management guidelines 1999. [Accessed On: June 10, 2020]. Available From URL: https://www.who.int/hiv/pub/sti/en/STIGuidelines2003.pdf.