"Syphilis can be a tricky disease to diagnose-especially when a patient may not be sharing the whole story. Doctors in Belgium met with a real head-scratcher when an 83-year-old married man came in with a rare form of secondary syphilis-the second of four stages of the sexually transmitted bacterial infection that has been called a "master of disguise." The man told doctors up front that he was in a monogamous 50-year-long marriage and had been sexually inactive in recent years following treatment for cancer."
"The case began when the elderly man showed up at an emergency department complaining of severe itchiness. They noted that a month prior, he had been seen by specialists for paralysis on one side of his face. At that time, doctors found that liver enzymes in his blood were also elevated. They assumed it was all caused by a viral infection, but he had tested negative for a variety of them, including HIV, Epstein-Barr, cytomegalovirus, and Hepatitis A, B, C, and E."
An 83-year-old man presented with severe itchiness, joint pain, malaise, anorexia, and episodic peripheral and facial swelling. One month earlier he had unilateral facial paralysis and persistent elevation of liver enzymes. Initial viral testing including HIV, Epstein–Barr virus, cytomegalovirus, and hepatitis A–E was negative. Differential considerations included medication-induced liver injury, inflammatory and autoimmune disorders, infections, and storage diseases. Further evaluation identified a rare form of secondary syphilis producing systemic, neurologic, and hepatic manifestations despite the patient reporting a 50-year monogamous marriage and sexual inactivity after cancer treatment.
Read at Ars Technica
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