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The subject: An 83-year-old gentleman in Belgium
The indications: The gentleman looked for medical advice at a hospital due to the fact that the muscles on one side of his face had grown weak abruptly, causing it to sag — a condition referred to as unilateral peripheral facial-nerve palsy. Also, he had lately experienced a fever, which had subsequently subsided.
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The man’s hepatic anomalies had not cleared by one week subsequently, but his facial-nerve paralysis resolved following a 10-day dosage of a potent corticosteroid. Although then, over the ensuing month, the man’s knees and ankles grew taut and sore, and his legs and feet — and at times his face, arms and hands — commenced to inflate. He communicated feeling commonly sick, he had put on 11 pounds (5 kilograms), and his urine had turned dark even though he had been imbibing more water than normal. Each of these indicators implied complications with his renal function.
Outside of the ailments found on his latest medical examinations, the patient had long-term elevated blood pressure, elevated cholesterol, an enlarged prostate and chronic obstructive pulmonary disease (COPD), for which he was taking medicines. He had additionally been identified as having rectal cancer 20 years earlier and accepted diverse therapies throughout the years. Both he and his wife of 50 years had been sexually inactive since that cancer remedy, he informed his physicians.
What transpired subsequently: After several weeks invested in and out of the hospital, the man went to a casualty ward after his skin instantly turned severely itchy. He presented a red, scaly eruption on his calves. A neurologic assessment exposed “normal motor strength, feeling, reflexes, coordination, and gait,” the physicians composed in a report of the matter.
At the ER, the patient was interrogated furthermore regarding his health background, at which moment he notified physicians that, during his military duty as a young man, he’d engaged in unprotected intercourse with various incidental partners. He communicated undergoing treatment for various sexually transmitted ailments (STIs) during that period although had forgotten the particular diagnoses.
Examinations unveiled that the patient was anemic and that his urine encompassed blood and an anomalous quantity of protein. Furthermore, an examination for autoimmune disorders discovered unusually high concentrations of antinuclear antibodies, which zero in on the regulator centers of cells that contain DNA. Because the patient had lately undergone facial-nerve paralysis, the physicians analyzed his cerebral spinal fluid — the clear liquid that encompasses the mind and spinal column. This exposed augmented concentrations of white blood cells, which hinted toward an active contamination.
The diagnosis: While examinations for HIV and tuberculosis came back negative, an assay for Treponema pallidum, the bacterium that induces syphilis, was positive, verifying that the patient had an active syphilis contamination.
Syphilis contaminations can advance across four phases, each presenting distinct indications. Supposing that an infected person doesn’t acquire efficient remedy during the primary and secondary stages, the bacteria can turn out to be latent, from time to time for decades. And in a fraction of cases, latent syphilis can reawaken and provoke a late, or tertiary, contamination.
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A more current, unreported exposure must be contemplated.
Based on his positive T. pallidum examination, rash, general sick sensation, abnormal liver results, high urinary protein value, leg swelling, facial drooping and swollen lymph nodes, the man’s physicians recognized him as having secondary syphilis with early neurosyphilis, where the bacteria besiege the nervous system.
The treatment: The patient had gotten a single injection of penicillin prior to the examination results confirming that his contamination involved neurological involvement. He was subsequently given a 14-day series of intravenous penicillin, which is the suggested remedy for neurosyphilis, in accordance with the case report.
The acute itching was dealt with via antihistamines, and he was prescribed diuretics to diminish the swelling in his legs. The rash, pruritus and distension had improved by his one-month follow-up session, and his liver examinations and urinary output had normalized.
Public health officials were apprised of the patient’s diagnosis, and his wife was directed for testing. The case report does not take note of whether his wife assessed positive for syphilis.
What renders the case exceptional: Secondary syphilis typically arises within the initial year of an untreated contamination and just infrequently emerges after four years have elapsed. Ordinarily, sleek, hard sores show up on the mouth or genitals during primary syphilis, and as soon as those sores vanish, secondary syphilis settles in within months, if left untreated.
OTHER DILEMMAS
—A toddler inadvertently ingested gonorrhea bacteria out of a lab dish
—Man contracted rabies via organ relocation following donor having been scratched by skunk
—Rare semen allergy could potentially have induced woman’s infertility
“Even though the patient’s history of multiple sexually transmitted contaminations as a young man motivated testing for syphilis, an exposure from that time frame wouldn’t be projected to explain his present presentation,” his physicians wrote.
There’s a likelihood that the man had a latent contamination that lately reactivated, perhaps because of the immune-suppressing impact of his recent steroid treatment. Although you’d expect the reactivation to solely trigger symptoms of tertiary syphilis — like nervous system problems — not symptoms linked with secondary syphilis, like fever, rash and weight reduction.
Therefore, definitively when the man contracted the contamination is uncertain. “A more current, unreported exposure must be contemplated,” the physicians wrote.
It is equally uncommon for syphilis to impact the liver and kidneys, occurring in less than 10% of instances, according to the case report.
For more intriguing medical instances, examine our Diagnostic Dilemma archives.
Disclaimer
This write-up serves exclusively for informational objectives and doesn’t seek to proffer medical advice.
Article Sources
Van Den Eynde, J., Van Der Pluijm, C., Schellekens, P., Vanhoutte, T., & Bammens, B. (2025). Spiraling into a Distant Past. New England Journal of Medicine, 393(18), 1844–1850. https://doi.org/10.1056/nejmcps2507868
TOPICSDiagnostic dilemma
Sophie BerdugoSocial Links NavigationStaff writer
Sophie functions as a U.K.-based staff writer at Live Science. She reports on a broad assortment of subjects, having in the past reported on studies encompassing from bonobo communication to the first water within the universe. Her work has additionally been showcased in outlets incorporating New Scientist, The Observer and BBC Wildlife, and she was shortlisted for the Association of British Science Writers’ 2025 “Newcomer of the Year” award for her freelance effort at New Scientist. Prior to evolving into a science journalist, she finished a doctorate in evolutionary anthropology from the University of Oxford, where she invested four years examining why certain chimps exhibit improved tool utilization capabilities than others.
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A man’s muscles appeared strangely misshapen. Doctors realized they were discharging calcium into his bloodstream.
A man’s bladder resembled a Christmas tree