PANCYTOPENIA: A RARE PRESENTATION OF SYPHILIS

Abstract

INTRODUCTION: Syphilis is caused by spirochete Treponema pallidum. A common mode of transmission is via sexual contact and mainly targeting high-risk populations such as those with Human Immunodeficiency Virus and men who have sex with men (MSM). It has a wide range of presentations based on the four main overlapping clinical stages. Due to the lack of vaccines to prevent syphilis, prompt diagnosis and management of infected persons are warranted to reduce disease burden and its clinical effects.  CASE PRESENTATION: We present an unorthodox case of pancytopenia in a 55-year-old male patient who developed chronic progressive weakness, generalized body aches, and intermittent fever. His blood tests revealed pancytopenia and bone marrow biopsy revealed caseous necrosis. Since the patient had a positive history of MSM, syphilis serology was sent, which turned out to be positive. The patient responded to intravenous benzylpenicillin and oral doxycycline. CONCLUSION: Of note, not every pancytopenia in the elderly is due to malignancy, bone marrow aplasia or acute viral / parasitic insult; other uncommon causes also exist. Syphilis should be kept among the differentials of pancytopenia when more common causes have been excluded. A good sexual history is pertinent to reaching the correct diagnosis in such cases.