Syphilis – a Differential Diagnosis for Cervical Lymph Node Swelling

Syphilis is a systemic sexually transmitted disease caused by the spirochaetes bacterium Treponema Pallidum. Persistent cervical lymph node swelling or B-symptomatology can be caused by this disease which can lead to the assumption of a malignant tumorous disease.We report a 25-year-old female patient presented with a painless, sonographically confirmed swelling of the cervical lymph nodes, as well as a feeling of weakness, fatigue, and unwanted weight loss.With persistence of the swelling as well as inconspicuous inflammatory parameters, a needle biopsy of one of the enlarged lymph nodes (4cm) was performed on suspicion of lymphoma. Histopathological examination revealed reactively altered lymph node tissue without evidence of malignancy.A diagnosis of syphilis was made based on infectious serology, which was followed by a single shot of 2.4 million IU of tardocillin intramuscularly. There was improvement of symptoms and slow regression of lymph node swelling.Infection occurred through the patient’s partner, who had unprotected sexual intercourse with different partners in a short time period prior to the relationship.Although the patient herself did not indicate any risk factors regarding infection with syphilis, this would have applied to her partner at that time. Further, typical primary symptoms such as chancre lesions were absent.In case of cervical lymph node swelling of unclear origin, the differential diagnosis of syphilis should be considered. In cases like the one present, it is advantageous to take a medical history regarding the sexual behavior and possible risk factors for syphilis and, if suspected, to obtain a specific serology of the infection.