A 36 year-old man presented with complaints of nausea of two months duration, 3-4 weeks of burning upper abdominal pain, and several days of protracted vomiting with intermittent hematemesis (vomiting of blood). He had no prior history of gastrointestinal disease, and denied use of aspirin, ibuprofen-like agents or other gastrointestinal irritants. During his illness he had lost 17 lbs.


Upper endoscopy demonstrated a 2.5 cm ulcer in the proximal gastric body (top photo), numerous stellate and serpiginous ulcers involving the gastric antrum extending into the pyloric channel (middle photo), and an inflamed, cobblestone appearance of the duodenum with superficial ulcerations (bottom photo).


Because of the unusual set of endoscopic findings, an RPR was obtained and was positive at 1:512; FTA was likewise positive. Cerebral spinal fluid VDRL was negative. Gastric and duodenal biopsies revealed both Helicobacter pylori and spirochetes (Treponema pallidum).