He underwent an exploratory laparotomy and was found to have several caseous liver masses, but no tumor. An infectious etiology was felt most likely and syphilis serologies were obtained. He was begun on penicillin therapy. Following treatment, he had resolution of his back pain and began to gain weight. Although about 25,000 cases of primary or secondary syphilis are diagnosed annually in the United States, tertiary syphilis is rare.
Primary syphilis is manifested by the chancre at the site of inoculation and by regional adenopathy.
Secondary syphilis may be manifested by a diffuse skin rash, and systemic symptoms which may include bone pain and hepatitis. Signs of symptoms generally subside spontaneously after 3-6 weeks and the disease then enters a latent phase. A gumma may be found in any organ, but skin and bone are the most frequent sites. The liver may be involved in secondary or tertiary syphilis. Gummata are seen in tertiary syphilis and in all recent case reports have been mistaken preoperatively for tumor.