Erosive Syphilitic Gastritis: Dark-Field and Immunofluorescent Diagnosis from Biopsy Specimen

A 42-year-old man with positive blood and spinal fluid findings for syphilis had clinical, radiologic, gastroscopic, and histologic evidence of a severe infiltrative and erosive gastritis involving the entire distal stomach. Gastric tissue obtained from gastroscopic biopsy contained numerous motile spirochetes on dark-field microscopy, with strongly positive specific treponemal immunofluorescence. The abnormalities resolved after a course of penicillin therapy. This case shows the propensity of late secondary syphilis to produce mucosal lesions in the stomach.