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Gummatous Syphilis of the Adrenal Gland

Scheurkogel, Merel M. MD*; Tim, Joris MD; Jeurissen, Franciscus J.F. MD, PhD; Quarles van Ufford, Henriette M.E. MD, PhD*

doi: 10.1097/RLU.0b013e318262adf1
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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:





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1. Singh AE, Romanowski B. Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features. Clin Microbiol Rev. 1999; 12: 187–209.
    2. McVey M, Cameron W, MacPherson P. When infections collide-gummatous syphilis in an HIV-infected individual. Int J Infect Dis. 2010; 14: 283–286.
      3. Dourmishev LA, Dourmishev AL. Syphilis: uncommon presentations in adults. Clin Dermatol. 2005; 23: 555–564.
        4. Ilogu N, Daidone P, Stefan T, et al.. Neurosyphilis and syphilitic gumma of the adrenal gland. Clin Infect Dis. 1998; 26: 224–225.
          5. Spyridonidis A, Otto F, Kraft A, et al.. Antibiotics for weight loss, osteolysis, hepatic and adrenal tumours. Lancet. 2002; 359: 1828.
            6. Pruzzo R, Redondo F, Amaral H, et al.. Anal and rectal syphilis on F-18 FDG PET/CT. Clin Nucl Med. 2008; 33: 809–810.
              7. Lin M, Darwish BS, Chu J. Neurosyphilitic gumma on F18-2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography: an old disease investigated with a new technology. J Clin Neurosci. 2009; 16: 410–412.
                8. Shim HJ. Tertiary syphilis mimicking hepatic metastases of underlying primary peritoneal serous carcinoma. World J Hepatol. 2010; 2: 362–366.
                  9. Wang X, Yin J, Chen X. Syphilitic bone destruction on FDG PET/CT. Clin Nucl Med. 2011; 36: 616–618.

                    gummatous syphilis; tertiary syphilis; CT; 18F-FDG PET

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