• Hyung-Joo Yu, Seong-Jung Kim, Hyung-Hoon Oh, Chan-Mook Im, Bora Han, Eun Myung, Sook-Jung Yun, Kyung-Hwa Lee, and Young-Eun Joo.
• Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
• Medicine (Baltimore). 2021 Dec 17; 100 (50): e28212e28212.

RationaleSyphilis is a contagious infectious disease caused by Treponema pallidum. Gastric involvement of syphilis is rare and has nonspecific gastrointestinal symptoms and endoscopic findings. To date, 16 cases have been reported in Korea. Here, we report 2 additional cases of gastric syphilis in men in their 30 second.Patients ConcernsTwo 35- and 33-year-old men presented with epigastric pain.DiagnosisThe serum venereal disease research laboratory and fluorescent treponemal antibody absorption tests were positive. Esophagogastroduodenoscopy showed multiple variable-sized flat elevated lesions and geographic ulcers with whitish exudates in the antrum and body. Warthin-Starry silver staining of endoscopic biopsy specimens confirmed gastric syphilis.InterventionsThe patients were treated with an intramuscular injection of 2.4 million units of benzathine penicillin once a week for 3 weeks.OutcomesClinical symptoms and gastric lesions were completely resolved.LessonsFirst, gastric syphilis, despite its rarity and nonspecific symptoms and endoscopic findings, should be considered in a rare extracutaneous presentation of syphilis. Second, a high index of clinical suspicion and an accurate diagnosis based on a combination of clinical, radiological, endoscopic, serologic, and histopathologic findings provide an opportunity to identify and treat patients with gastric syphilis.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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