Case 216. Syphilitic lymphadenitis (42 y-o M)
Cervical lymph node biopsied from a febrile man with a high titer of TPHA
Key words : Treponema pallidum, gumma, tertiary syphilis
sexually transmitted infection
The enlarged node is multifocally replaced by epithelioid granulomas (HE, low power). No caseous necrosis is seen. The features represent tertiary syphilis forming gumma.   Formation of epithelioid granuloma with Langhans-type giant cells is evident histologically (HE). In this case, the diagnosis of "granulomatous lymphadenitis" is unsatisfactory. Etiological seeking is important, particularly when the possibility of syphilis is clinically not suspected.
A few spiral pathogens are identified in the granulomatous lesion by immunostaining for Treponema pallidum antigens, confirming the diagnosis of tertiary syphilis. Warthin-Starry's silver was negative.