A 55-year-old man with no relevant history was analyzed for weight loss, night sweats, and left upper quadrant pain. An abdominal ultrasound and CT scan were performed, revealing a lobulated rim-enhancing mass in the left adrenal gland. Further analysis by an 18F-FDG PET/CT scan demonstrated high uptake in the periphery of the adrenal lesion with central photopenia. Because a primary malignancy was suspected, an adrenalectomy was performed. Histopathology, however, revealed a necrotizing granulomatous infection. Serum was tested positive for syphilis and Treponema pallidum infection. Results of additional HIV tests were negative. The adrenal tumor proved to be an expression of gummatous syphilis.
From the Departments of *Radiology, †Nuclear Medicine, and ‡Internal Medicine, Medical Center Haaglanden, The Hague, Netherlands.
Received for publication December 13, 2011; and revision accepted April 23, 2012.
Conflicts of interest and sources of funding: none declared.
Reprints: Merel M. Scheurkogel, MD, Department of Radiology, Medical Center Haaglanden, Lijnbaan 32, 2501 CK The Hague, Netherlands. E-mail: email@example.com.