SHM Converge Scientific Abstract ePoster Gallery-Atypical Syphilis Revealed: Bilateral Leg Dema and Conjunctivitis in a Young Adult

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This case describes a 20-year-old man with no significant past medical history who presented with acute bilateral lower-extremity edema, ankle pain, purpuric lesions, erythema, palpitations, fever, and conjunctivitis. He was initially treated for presumed bilateral cellulitis with cefepime and vancomycin, but the differential also included vasculitis and other inflammatory conditions. Ophthalmology found bilateral conjunctivitis, and brain CT was normal.<br /><br />A detailed history revealed a sexual encounter with a male partner three months earlier, raising suspicion for a sexually transmitted infection. Diagnostic testing showed a positive RPR and reactive CSF treponemal antibody, supporting a diagnosis of syphilis with concern for early neurosyphilis. Autoimmune workup was negative, helping rule out rheumatologic causes. He was discharged on penicillin G with follow-up.<br /><br />The report emphasizes that syphilis can present in highly atypical ways and mimic more common disorders such as cellulitis, vasculitis, or stasis dermatitis. In this patient, the absence of classic findings like palmar or plantar lesions and lymphadenopathy made the diagnosis less obvious. The case highlights the importance of obtaining a thorough social and sexual history, maintaining a broad differential diagnosis, and considering infectious causes early when evaluating bilateral leg erythema, edema, and purpura.<br /><br />Overall, the case illustrates how syphilis remains a “great mimicker” and how early serologic testing can prevent diagnostic delay and ensure prompt treatment.

Asset Subtitle

Carlos G. Martinez Bauza

Meta Tag

Author List Carlos G. Martinez Bauza, Geoffrey Y. Zhang, Lauren v. Robinson, Nikhil Seth, Pradyun v. Sangineni, Samuel A. Sara

Category Clinical Vignettes

Concept Syphilis

Concept Differential Diagnosis

Concept Sexual History

Concept Syphilis Serology

Concept Treponemal Test

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Carlos G. Martinez Bauza

Track Adult

Keywords

syphilis

neurosyphilis

bilateral edema

purpuric lesions

conjunctivitis

cellulitis mimic

vasculitis differential

RPR positive

penicillin G

sexual history

Syphilis

Differential Diagnosis

Sexual History

Syphilis Serology

Treponemal Test