Visceral crises may occur in patients with late neurosyphilis and tabes dorsalis. The diagnosis can be challenging if the patient is not known to have late syphilis.
The key feature is an attack of severe pain with patient distress suggesting an acute surgical emergency.
Gastric crisis:
(1) severe epigastric pain
(2) nausea and vomiting
Intestinal crisis:
(1) severe abdominal pain
(2) diarrhea
Rectal crisis:
(1) severe rectal pain
(2) tenesmus
(3) may be associated with fecal incontinence
Genitourinary crisis:
(1) severe pelvic or bladder pain
(2) may be associated with urinary incontinence or impotence
Laryngeal crisis:
(1) stridor
(2) hoarseness
(3) severe pain in the larynx
Pharyngeal crisis:
(1) severe pain in the throat
(2) difficulty swallowing
A visceral crisis usually occurs in a patient with tabes dorsalis. Other manifestations of late neurosyphilis should be looked for if the diagnosis is suspected.
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