[Anticytoplasmic antibodies (cANCA) in syphilitic nodules of the lung].
METHODS
A chest radiograph was done in a 75-year-old man with cough productive of a whitish sputum. It showed round foci in the right middle and upper lobes. Serum anticytoplasmic antibody (cANCA) was 1 : 160, suggesting Wegener's granulomatosis. But the pulmonary foci actually increased in size on administration of prednisolone, 10 mg daily.


METHODS
As the lung biopsy was not diagnostic, a diagnostic thoracotomy with biopsy was done and the anterior segment of the right middle lobe resected. Histological examination revealed a gumma. Active syphilis was confirmed by a TPHA-Test with a titre of 1 : 40960.


METHODS
Antisyphilitic treatment was given for 35 days, at first 1 mega (Penicillin E daily for five days, then erythromycin, 1000 mg, for five days, a penicillin rash having occurred. Serial serology showed a continual fall of the lues and cANCA titres. Four months postoperatively the titre in the TPHA test had fallen to 1 : 640, and was nonreactive after five years. cANCA titre fell to 1 : 16 and was negative 42 weeks after resection.


CONCLUSIONS
The connection between pulmonary gumma and the presence of antiplasmatic antibodies remains unclear. Inflammatory changes in the vascular wall, which occur in both Wegener's granulomatosis and tertiary syphilis, may have played a role.
Wöckel
W
W
Pathologisches Institut, Zentralkrankenhauses Gauting, LVA Oberbayern.
Häussinger
K
K
Weis
R
R
Morresi-Hauf
A
A
D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood*; D001706:Biopsy; D003937:Diagnosis, Differential; D014890:Granulomatosis with Polyangiitis / Q000175:diagnosis; D006801:Humans; D008171:Lung Diseases / Q000276:immunology* / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D008297:Male; D013587:Syphilis / Q000175:diagnosis* / Q000276:immunology* / Q000473:pathology; D013908:Thoracotomy
D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies; D015415:Biomarkers