SHM Converge Scientific Abstract ePoster Gallery-A Mind-Numbing Problem: Secondary Syphilis Masquerading as Metastatic Cancer

Pdf Summary

This case report describes a 56-year-old man with well-controlled HIV who presented with three weeks of headache, night sweats, subjective fever, and three days of bilateral chin numbness. Initial evaluation showed elevated liver enzymes, a bland cerebrospinal fluid profile, and imaging findings that were highly concerning for metastatic cancer: MRI/MRA suggested inflammation or infiltration of the pituitary infundibulum, mandibular bodies, and mental nerves, while CT of the abdomen/pelvis revealed about 20 bilateral hepatic lesions.<br /><br />Because chin numbness can indicate “numb chin syndrome,” often associated with malignancy, the initial concern was metastatic disease. The patient initially chose outpatient liver biopsy. At a primary care follow-up one week later, he reported persistent symptoms and had developed a papulopustular rash. A more detailed sexual history revealed a recent partner with known syphilis exposure, and repeat serology showed a dramatic rise in RPR from 1:4 three months earlier to 1:256. He was then diagnosed with secondary syphilis with involvement of the skin, liver, central nervous system, and peripheral nerves.<br /><br />He completed 14 days of intravenous penicillin G, with prompt resolution of fever, rash, and headache. At five-month follow-up, repeat CT imaging showed a decrease in the size of hepatic lesions without new lesions, and liver enzymes normalized. Chin numbness remained stable.<br /><br />The report emphasizes that syphilis remains a “great imitator” and can rarely mimic metastatic cancer, including presenting with bilateral numb chin syndrome and multiple hepatic lesions. It highlights the importance of careful history-taking, physical examination, and maintaining a high index of suspicion to avoid misdiagnosis.

Asset Subtitle

April S. Liang

Meta Tag

Author List April S. Liang, Cristina E. Brickman, Peter Barish

Category Clinical Vignettes

Concept Secondary Syphilis

Concept Syphilis

Concept Numb Chin Syndrome

Concept Penicillin

Concept Sensory Neuropathy

Distinguished Non-Finalist

Presenter Organization Ucsf

Presenting Author April S. Liang

Track Adult

Keywords

secondary syphilis

numb chin syndrome

hepatic lesions

HIV

neurosyphilis

metastatic cancer mimic

penicillin G

papulopustular rash

RPR titer

central nervous system involvement

Secondary Syphilis

Syphilis

Numb Chin Syndrome

Penicillin

Sensory Neuropathy