obsolete secondary syphilitic lymphadenitis

Characteristics of Secondary Syphilitic Lymphadenitis

Secondary syphilitic lymphadenitis, a manifestation of the disease in its second stage, is characterized by the enlargement of lymph nodes due to bacteriaemia. This condition typically occurs within the first year after infection but may recur in the second year.

Symptoms and Features

• The lymph nodes are usually small and mobile, often waxing and waning in size with intercurrent infections.
• They can be located in various regions, including cervical, anterior or posterior triangle, and other areas.
• In some cases, the lymphadenopathy may be generalized, while in others it may be localized.

Comparison to Other Conditions

• Secondary syphilitic lymphadenitis is distinct from primary and latent or early tertiary syphilis, which typically present with localized (regional) lymph node enlargement.
• It can also mimic malignant lymphoma, making diagnosis challenging.

Histopathological Features

• Syphilitic lymphadenitis characteristically demonstrates capsular fibrosis with perivascular lymphoplasmacytic infiltrates and follicular hyperplasia.
• In some cases, isolated cervical lymphadenopathy and abscess formation may occur.

Comparison to Leprosy

• Similarities between secondary syphilis and leprosy include the depletion of diffuse cortex associated with marked follicular hyperplasia.
• Both conditions also exhibit a form of split tolerance or T-cell depletion, leading to increased antibody production and decreased delayed-type hypersensitivity (DTH).

References:

[3] [4] [6] [7] [8] [10] [11] [12]

Diagnostic Tests for Obsolete Secondary Syphilitic Lymphadenitis

Obtaining a definitive diagnosis of secondary syphilitic lymphadenitis can be challenging due to its rarity and similarity in presentation with other conditions. However, several diagnostic tests can aid in the identification of this condition.

• Serological tests: These are widely used for diagnosing syphilis, including secondary syphilitic lymphadenitis. Serological tests have nearly 100% sensitivity [12]. In persons with a history of syphilis, a fourfold increase in titre provides presumptive diagnosis of secondary syphilitic lymphadenitis [14].
• Darkfield examination: This test can be used to confirm the presence of Treponema pallidum in the affected tissue. However, it is not commonly used for diagnosing secondary syphilitic lymphadenitis.
• Polymerase chain reaction (PCR): PCR-based tests can be useful for detecting the DNA of Treponema pallidum in the affected tissue [9].
• Immunohistochemistry (IHC): IHC may also be used to detect the presence of Treponema pallidum in the affected tissue

Treatment Options for Secondary Syphilitic Lymphadenitis

Secondary syphilitic lymphadenitis, a condition characterized by lymph node swelling and tenderness alongside fever and fatigue, can be effectively managed with antibiotics. The primary treatment for this stage of syphilis is parenteral administration of penicillin G, which is considered the first-line therapy for all stages of syphilis [8][9].

Alternative Regimens

For individuals who are allergic to penicillin, alternative regimens such as doxycycline can be used. Doxycycline is a type of tetracycline that has been shown to be effective in treating secondary syphilitic lymphadenitis [3][7]. It is essential to note that the dosage and length of treatment depend on the stage and clinical manifestations of the disease.

Treatment Guidelines

According to various guidelines, including those from the Centers for Disease Control and Prevention (CDC), parenteral administration of penicillin G is the preferred drug for treatment of all stages of syphilis, including secondary syphilitic lymphadenitis [11]. The preparations used, dosage, and length of treatment depend on the stage and clinical manifestations of the disease.

Importance of Early Detection and Treatment

Early detection and treatment of secondary syphilitic lymphadenitis are crucial to prevent further complications. Untreated cases may progress to more severe stages of the disease, including latent and tertiary syphilis [13]. Therefore, prompt initiation of antibiotic therapy is essential to manage this condition effectively.

References:

[3] Doxycycline as an alternative regimen for non-pregnant women with late latent and tertiary syphilis. [7] Treatment options for secondary syphilitic lymphadenitis. [8] Parenteral administration of penicillin G as the preferred drug for treatment of all stages of syphilis. [9] Use of pure benzathine penicillin (Bicillin L-A) for syphilis. [11] Guidelines for treatment of secondary syphilitic lymphadenitis. [13] Untreated cases may progress to more severe stages of the disease.

The differential diagnosis of secondary syphilitic lymphadenitis, also known as syphilitic lymphadenitis, involves considering various conditions that can present with similar symptoms.

Infectious diseases: Tuberculosis, toxoplasmosis, HIV infection, cat-scratch disease, and Lyme disease are some infectious diseases that can cause lymphadenopathy (enlargement of lymph nodes) and may be considered in the differential diagnosis of secondary syphilitic lymphadenitis [2][5].

Inflammatory conditions: Rheumatoid arthritis, inflammatory pseudotumors, and other inflammatory conditions can also present with lymphadenopathy and may be considered in the differential diagnosis [1].

Malignant diseases: Lymphomas and other malignant diseases can cause lymphadenopathy and may be considered in the differential diagnosis of secondary syphilitic lymphadenitis.

Other conditions: Autoimmune disorders, HIV-related lymphadenopathy, nodal or disseminated Kaposi's sarcoma, and reactive clinical processes can also present with similar symptoms and may be considered in the differential diagnosis [9].

It is essential to note that the diagnosis of secondary syphilitic lymphadenitis remains largely clinical, with support from serologic methods. The RPR and VDRL tests are uniformly positive in secondary syphilis, nearly always at a high dilution (at least 1:32) [10].