You are using an outdated browser. Please upgrade your browser to improve your experience.
Become a Fellow
ACP offers a number of resources to help members make sense of the MOC requirements and earn points.
Understanding MOC Requirements
Earn MOC points
The most comprehensive meeting in Internal Medicine.
April 11-13, 2019
Internal Medicine Meeting 2019
Prepare for the Certification and Maintenance of Certification (MOC)
Exam with an ACP review course.
Board Certification Review Courses
MOC Exam Prep Courses
Treating a patient? Researching a topic? Get answers now.
Visit AnnalsLearn More
Visit MKSAP 18Learn More
Visit DynaMed Plus
Ensure payment and avoid policy violations. Plus, new resources to help you navigate the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Access helpful forms developed by a variety of sources for patient charts, logs, information sheets, office signs, and use by practice administration.
ACP advocates on behalf on internists and their patients on a number of timely issues. Learn about where ACP stands on the following areas:
© Copyright 2018 American College of Physicians. All Rights Reserved. 190 North Independence Mall West, Philadelphia, PA 19106-1572
Toll Free: (800) 523.1546 · Local: (215) 351.2400
Author: Catherine L. Meeker, Oregon Health
& Science University School of Medicine, Class of 2014
Introduction: The characteristic feature of
secondary syphilis is a rash, but its lesser-known symptoms create
a presentation that can mimic mononucleosis, primary HIV, or other
clinical entities. We report the case of an uncommon presentation
of syphilis in a patient who presented with abdominal pain,
B-symptoms, and a large abdominal mass concerning for a GI
Case Presentation: A previously healthy 20
year-old homosexual male presented to our medical center with one
week of fevers, chills, night-sweats, and severe epigastric pain,
three weeks after being evaluated at an outside urgent care center
for a sore throat and penile irritation, both of which resolved in
the interim period. Triage vital signs were T 37.9 °C, HR 128,
RR 16, BP 119/49, Sp02 98% RA. Physical exam was notable for a
thin, pale Caucasian male with severe epigastric tenderness to
palpation without peritoneal signs. Non-tender bilateral 1cm
inguinal lymph nodes were appreciated. Genital exam was otherwise
unremarkable. An abnormal abdominal ultrasound in the ED prompted a
CT, which revealed a periportal soft tissue mass measuring
2.5x7.0x8.5cm with multiple aortocaval and periaortic lymph nodes.
Admission labs were remarkable for a WBC of 18.9K/mm3 with 85%
neutrophils and no bandemia. LFTs and lipase were normal.
An excisional biopsy of an inguinal lymph node was pursued.
chemical analysis of the specimen was negative for lymphoma and
prototypical viruses. Similarly, serum PCR assays for EBV, CMV,
HHV-6, and HIV were negative. With supportive care, his symptoms
abated with concomitant normalization of his WBC. However, his
alkaline phosphatase steadily rose, peaking at 319U/L. He was
discharged on hospital day 7 with close outpatient follow up.
At his follow-up clinic visit, the patient was found to have
continued elevation of alkaline phosphatase with new thrombocytosis
to 739K/mm3. Further scouring of literature prompted sending an
RPR, which came back reactive. State lab FTA testing confirmed the
diagnosis of syphilis. He was treated appropriately with IM
penicillin G with subsequent resolution of his symptomatology and
Discussion: In 2010, there were 45,834 new
cases of syphilis, with the highest rates among men ages 20-29,
with MSM accounting for 2/3 of all new cases of early-stage
syphilis. Despite the fact that our patient was 20 years old and
homosexual, syphilis was not on our initial differential because he
lacked genital lesions, a rash, and/or neurological symptoms. We
report this case to highlight the importance including syphilis on
the differential for GI lymphoma, and to emphasize the less common
signs and symptoms of secondary syphilis, a disease that is easily
treatable if recognized early.
July 2013 Issue of IMpact