{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T09:04:00Z","timestamp":1794215040705,"version":"4.8.0"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"C","license":[{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T00:00:00Z","timestamp":1685577600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T00:00:00Z","timestamp":1684972800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Syphilis is an infectious disease that is uncommonly encountered in surgical patients. We present a case of severe syphilitic proctitis leading to large bowel obstruction with imaging findings mimicking locally advanced rectal cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Presentation of case:<\/jats:title>\n                    <jats:p>A 38-year-old man who had sex with men presented to the emergency department with a 2 week history of obstipation. The patient's medical history was significant for poorly controlled HIV. Imaging demonstrated a large mass in the rectum and the patient was admitted to the colorectal surgery service for management of presumed rectal cancer. Sigmoidoscopy demonstrated a rectal stricture and biopsies showed severe proctitis without evidence for malignancy. Given the patient's history and discordant clinical findings an infectious workup was pursued. The patient tested positive for syphilis and was diagnosed with syphilitic proctitis. He underwent treatment with penicillin and although he experienced a Jarisch-Herxheimer reaction, his bowel obstruction completely resolved. Final pathology on the rectal biopsies demonstrated positive Warthin-Starry and spirochete immunohistochemical stain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>This case illustrates key aspects in the care of a patient with syphilitic proctitis mimicking an obstructing rectal cancer, including the need for high clinical suspicion, thorough evaluation including sexual and sexually transmitted disease history, multidisciplinary communication, and management of the Jarisch-Herxheimer reaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Severe proctitis leading to large bowel obstruction is a possible presentation of syphilis, and a high degree of clinical suspicion is necessary to be able to accurately identify the cause. An increased awareness of the Jarisch-Herxheimer reaction following treatment of syphilis is critical to provide appropriate care in this patient population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2023.108358","type":"journal-article","created":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T02:20:00Z","timestamp":1685413200000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":8,"title":["Syphilitic proctitis presenting as locally advanced rectal cancer"],"prefix":"10.1097","volume":"107","author":[{"given":"Brandon","family":"Peine","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kieran J.","family":"Ved","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Fleming","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Honaker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-59-20260318","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1016\/S0140-6736(16)32411-4","article-title":"Syphilis","volume":"389","author":"Hook","year":"2017","journal-title":"Lancet"},{"key":"R2-59-20260318","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1056\/NEJMra1901593","article-title":"The modern epidemic of syphilis","volume":"382","author":"Ghanem","year":"2020","journal-title":"N. 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Belg"},{"key":"R8-59-20260318","doi-asserted-by":"crossref","first-page":"4394","DOI":"10.1128\/JCM.01240-11","article-title":"Case of secondary syphilis presenting with unusual complications: syphilitic proctitis, gastritis, and hepatitis","volume":"49","author":"Adachi","year":"2011","journal-title":"J. Clin. Microbiol"},{"key":"R9-59-20260318","doi-asserted-by":"crossref","first-page":"276","DOI":"10.3349\/ymj.2010.51.2.276","article-title":"Rectal syphilis mimicking rectal cancer","volume":"51","author":"Cha","year":"2010","journal-title":"Yonsei Med. J"},{"key":"R10-59-20260318","doi-asserted-by":"crossref","first-page":"112","DOI":"10.4291\/wjgp.v1.i3.112","article-title":"Syphilitic proctitis mimicking rectal cancer: a case report","volume":"1","author":"Zhao","year":"2010","journal-title":"World J. Gastrointest. Pathophysiol"},{"key":"R11-59-20260318","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.ijsu.2020.10.034","article-title":"The SCARE 2020 guideline: updating consensus surgical case report (SCARE) guidelines","volume":"84","author":"Agha","year":"2020","journal-title":"Int. J. Surg"},{"key":"R12-59-20260318","doi-asserted-by":"crossref","first-page":"46","DOI":"10.4269\/ajtmh.16-0434","article-title":"The Jarisch-Herxheimer reaction after antibiotic treatment of spirochetal infections: a review of recent cases and our understanding of pathogenesis","volume":"96","author":"Butler","year":"2017","journal-title":"Am. J. Trop. Med. Hyg"},{"key":"R13-59-20260318","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1086\/656419","article-title":"Jarisch-Herxheimer reaction after penicillin therapy among patients with syphilis in the era of the hiv infection epidemic: incidence and risk factors","volume":"51","author":"Yang","year":"2010","journal-title":"Clin. 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