SHM Converge Scientific Abstract ePoster Gallery-Spirochete Inside Your Seat

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This case report describes a 59-year-old man with HIV, hepatitis B, and amphetamine use disorder who presented with fever, diffuse abdominal pain, rectal pain, and purulent rectal discharge. He also reported receptive anal intercourse and prior rectal methamphetamine use. On exam, he was septic, febrile, tachycardic, and had lower abdominal tenderness without peritoneal signs.<br /><br />Initial evaluation considered infectious proctitis, inflammatory bowel disease, and malignancy. Rectal cultures were negative for gonorrhea, chlamydia, and HSV. Imaging and endoscopy showed inflammatory rectal changes, including rectal wall thickening, erythema, friability, and ulceration. Biopsy demonstrated acute-on-chronic inflammation with ulceration and numerous plasma cells. Immunohistochemical staining of the rectal biopsy identified spirochetes, and the patient had a reactive RPR with a titer of 1:64, confirming syphilitic proctitis.<br /><br />The report emphasizes that syphilitic proctitis is uncommon but should be included in the differential diagnosis of proctitis, especially in men who have sex with men and in patients with HIV. Its presentation can closely mimic ulcerative colitis, colorectal cancer, and other infectious causes of proctitis. Diagnosis can be confirmed with positive RPR serology and immunohistochemical detection of Treponema pallidum.<br /><br />The discussion highlights that syphilis remains a major global health problem, with increasing incidence in recent years. Recognizing atypical presentations such as rectal syphilis is important to ensure timely treatment, prevent complications, and reduce transmission.

Asset Subtitle

Sara Bidarian

Meta Tag

Author List Aaron Brenner, Megan Wolak, Sara Bidarian

Category Clinical Vignettes

Concept Proctitis

Concept Syphilitic Proctitis

Concept Syphilis

Concept Differential Diagnosis

Concept Infectious Cause

Distinguished Non-Finalist

Presenter Organization University of Kentucky College of Medicine

Presenting Author Sara Bidarian

Track Adult

Keywords

syphilitic proctitis

HIV

Treponema pallidum

rectal biopsy

reactive RPR

proctitis

infectious proctitis

ulcerative colitis mimic

rectal discharge

men who have sex with men

Proctitis

Syphilitic Proctitis

Syphilis

Differential Diagnosis

Infectious Cause