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Sánchez-Martínez E, Schaller J. Granulomatous Folliculotropic Secondary Syphilis: An Unusual Histopathological Clue. Am J Dermatopathol 2024:00000372-990000000-00403. [PMID: 39141747 DOI: 10.1097/dad.0000000000002821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
ABSTRACT Syphilis is a sexually transmitted disease that can present a wide variety of clinical and histopathological manifestations. We present the case of a 75-year-old patient with a persistent maculopapular rash on the trunk and extremities, in which the biopsy showed an exclusively perifollicular granulomatous infiltrate. In the immunohistochemical staining with anti-Treponema pallidum antibodies, spirochetes scattered within the perifollicular inflammatory infiltrate were identified. These findings together with the serological analysis allowed the diagnosis of secondary syphilis. Folliculotropic nonalopecic syphilis is rare, and the pathogenic mechanisms that cause this specific tropism are unknown. On the other hand, granulomatous inflammation is a pattern typically described in tertiary syphilis but also occasionally found in secondary syphilis. We present a case of secondary syphilis with the combination of both histopathological findings, an uncommon constellation for dermatopathologists to consider.
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2
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McKenzie NC, Hickey MD, De la Sancha C, Coates SJ, Leslie KS. Ulcerative erythematous papules and plaques on the face and lower legs of a man living with HIV: a clinicopathological challenge. Int J Dermatol 2024. [PMID: 38965065 DOI: 10.1111/ijd.17362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/15/2024] [Accepted: 06/23/2024] [Indexed: 07/06/2024]
Abstract
A 44-year-old male presented with a 2-month history of erythematous ulcerative papules and plaques on the scalp, face, and bilateral lower legs. He had a 5-year history of well-controlled HIV on antiretroviral therapy and recurrent syphilis infections. His face had violaceous plaques, while bilateral ankles and calves had ulcerative lesions with necrotic centers and purple borders. The morphologies clinically mimicked pyoderma gangrenosum on the lower extremities and cutaneous lymphoma on the face. Biopsy and reactive rapid plasma reagin confirmed a diagnosis of lues maligna, and the patient was successfully treated with penicillin G benzathine.
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Affiliation(s)
| | - Matthew D Hickey
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Carlo De la Sancha
- Department of Pathology, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Sarah J Coates
- Department of Dermatology, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Kieron S Leslie
- Department of Dermatology, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
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Valle K, Tinker D, Hanson J, Dilworth D. Cryptic papulonodular eruption with fever and vision loss. JAAD Case Rep 2024; 48:125-127. [PMID: 38826626 PMCID: PMC11143782 DOI: 10.1016/j.jdcr.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Affiliation(s)
- Kostandin Valle
- University of Missouri-Columbia School of Medicine, Columbia, Missouri
| | - Daniel Tinker
- Department of Dermatology, Saint Louis University, St Louis, Missouri
| | - Jamie Hanson
- Department of Dermatology, Saint Louis University, St Louis, Missouri
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Yilmaz K, Fahimi S, Huebers C, Géraud C. Der große Imitator: Sekundäre Syphilis unter dem klinischen Bild einer Psoriasis palmoplantaris: The great impostor: Secondary syphilis imitating palmoplantar psoriasis. J Dtsch Dermatol Ges 2024; 22:442-445. [PMID: 38450893 DOI: 10.1111/ddg.15316_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/30/2023] [Indexed: 03/08/2024]
Affiliation(s)
- Kaan Yilmaz
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim und Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg
| | - Sarah Fahimi
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim und Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg
| | - Corinne Huebers
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim und Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg
| | - Cyrill Géraud
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim und Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg
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5
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Yilmaz K, Fahimi S, Huebers C, Géraud C. The great impostor: Secondary syphilis imitating palmoplantar psoriasis. J Dtsch Dermatol Ges 2024; 22:442-445. [PMID: 38279546 DOI: 10.1111/ddg.15316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/30/2023] [Indexed: 01/28/2024]
Affiliation(s)
- Kaan Yilmaz
- Department of Dermatology, University Medical Center and Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sarah Fahimi
- Department of Dermatology, University Medical Center and Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Corinne Huebers
- Department of Dermatology, University Medical Center and Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Cyrill Géraud
- Department of Dermatology, University Medical Center and Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Birmingham SW, Saeed L, Thurlow CM, Vilfort K, Pillay A, Rojek NW, Doan LT, Lee BA. Round Bodies Detected by Treponema pallidum Immunohistochemical Stain in Two Cases of Cutaneous Syphilitic Gummata. Am J Dermatopathol 2024; 46:31-35. [PMID: 37982491 DOI: 10.1097/dad.0000000000002583] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
ABSTRACT Tertiary syphilis may present a diagnostic challenge due to negative nontreponemal serologies in up to 30% of cases and frequent lack of identifiable spirochetes on histopathology or other direct detection tests. We report 2 cases of round bodies staining with Treponema pallidum immunohistochemistry by light microscopy in biopsies from cutaneous syphilitic gummata. In 1 case, the finding was validated 3 times by 2 independent laboratories; in the other case, T. pallidum was detected by polymerase chain reaction in the biopsy sample. Spirochete round bodies have previously been reported in the setting of electron microscopy and fluorography, but to the best of our knowledge, have not been reported by light microscopy in a routine skin biopsy. Although the clinical implications are unclear, this may represent a helpful new paradigm for the diagnosis of tertiary syphilis.
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Affiliation(s)
| | - Lina Saeed
- Department of Dermatology, University of California, Irvine, Irvine, CA; and
| | - Charles M Thurlow
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kendra Vilfort
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Allan Pillay
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Nathan W Rojek
- Department of Dermatology, University of California, Irvine, Irvine, CA; and
| | - Linda T Doan
- Department of Dermatology, University of California, Irvine, Irvine, CA; and
| | - Bonnie A Lee
- Department of Dermatology, University of California, Irvine, Irvine, CA; and
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Patel P, Turbin RE, Husain S, Wang S. Neurosyphilis Mimicking Connective Tissue Disease. BMJ Case Rep 2023; 16:e256301. [PMID: 37770241 PMCID: PMC10546142 DOI: 10.1136/bcr-2023-256301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
A male in his 60s developed a pruritic, maculopapular rash on his torso and arms, sparing his palms and soles. He tested positive for ANA and an initial skin biopsy identified "bullous lupus," supporting the diagnosis of a connective tissue disease. Additional symptoms included headaches, facial nerve palsy and hearing loss, which partially responded to oral corticosteroids. He subsequently developed a steroid-dependent left eye scotoma, neuroretinitis and optic nerve papillitis. Mycophenolate mofetil was added but an attempted oral steroid taper led to a worsening rash, progressive retinitis and papillitis. Neurosyphilis was confirmed by serum positive rapid plasma reagin test, reactive treponema pallidum antibodies, positive cerebrospinal fluid venereal disease research laboratory and positive spirochete immunostain of skin biopsy of lesional (rash) tissue. Treatment with intravenous ceftriaxone resolved his rash and visual symptoms. It is important to consider syphilis as a mimicker of connective tissue diseases.
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Affiliation(s)
- Pooja Patel
- Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Roger E Turbin
- Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Sameera Husain
- Division of Dermatopathology, Columbia University, New York, New York, USA
| | - Shuwei Wang
- Division of Rheumatology, Department of Medicine, VA New Jersey Health Care System, East Orange, New Jersey, USA
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Rosa MFDAP, Quintella LP, Ferreira LC, Cuzzi T. Immunohistochemical detection of Treponema pallidum in skin samples with clinical and histopathological correlations and Warthin-Starry staining critical analysis. An Bras Dermatol 2023; 98:480-486. [PMID: 36906465 PMCID: PMC10334320 DOI: 10.1016/j.abd.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Syphilis in its different phases may be a difficult diagnosis in clinical and histopathological grounds. OBJECTIVES The present study objectives were to evaluate the detection and tissue distribution of Treponema pallidum in skin lesions of syphilis. METHODS A blinded diagnostic accuracy study was performed with immunohistochemistry and Warthin-Starry silver staining in skin samples from patients with syphilis and other diseases. Patients attended two tertiary hospitals between 2000 and 2019. Prevalence ratios (PR) and 95% confidence intervals (95% CI) were calculated for the association between immunohistochemistry positivity and clinical-histopathological variables. RESULTS Thirty-eight patients with syphilis and their 40 biopsy specimens were included in the study. Thirty-six skin samples were used as non-syphilis controls. The Warthin-Starry technique was unable to accurately demonstrate bacteria in all samples. Immunohistochemistry showed spirochetes only in skin samples from patients with syphilis (24/40) with 60% sensitivity (95% CI 44.8‒75.2). Specificity was 100% and accuracy, 78.9% (95% CI 69.8‒88.1). Most cases had spirochetes in both dermis and epidermis and there was a high bacterial load. STUDY LIMITATIONS Correlation between immunohistochemistry and clinical or histopathological characteristics was observed but was limited statistically due to the small sample size. CONCLUSIONS Spirochetes were promptly seen in an immunohistochemistry protocol, which can contribute to the diagnosis of syphilis in skin biopsy samples. On the other hand, the Warthin-Starry technique showed to be of no practical value.
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Affiliation(s)
| | - Leonardo Pereira Quintella
- Anatomical Pathology Service, National Institute of Infectious Diseases, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Luiz Claudio Ferreira
- Anatomical Pathology Service, National Institute of Infectious Diseases, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Tullia Cuzzi
- Department of Pathology, Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Lin W, Huang J, Guo S, Zhao M, Chen X, Shang Q, Zhang R, Liao G, Zheng J, Liao Y. A tunable fluorescent probe for superoxide anion detection during inflammation caused by Treponema pallidum. J Mater Chem B 2023; 11:4523-4528. [PMID: 37161601 DOI: 10.1039/d3tb00747b] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Syphilis, caused by Treponema pallidum (T. pallidum), is associated with the oxidative stress due to its inflammation-like symptom, and detecting the reactive oxygen species (ROS) is crucial for monitoring the infectious process. Herein, we design and synthesize a perylene-based tunable fluorescent probe, PerqdOH, which can detect endogenous O2˙- during T. pallidum infection. The fluorescence peak shifted from 540 nm to 750 nm with increasing O2˙- levels. Besides, both decreased green fluorescence and enhanced red fluorescence could be observed simultaneously during the in vitro infection, providing the real-time monitoring of intracellular O2˙- caused by T. pallidum. Furthermore, the probe exhibited a remarkable signal in the treponemal lesions on the back of a rabbit model. Taken together, our synthesized PerqdOH holds great potential for application in clarifying the infectious process caused by T. pallidum in real time.
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Affiliation(s)
- Weiqiang Lin
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, P. R. China.
| | - Jialin Huang
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, P. R. China.
| | - Shuang Guo
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, P. R. China.
| | - Meijiao Zhao
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, P. R. China.
| | - Xu Chen
- Department of Infectious Disease, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000, P. R. China
| | - Qiuping Shang
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, P. R. China.
| | - Ruoyuan Zhang
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, P. R. China.
| | - Guangfu Liao
- College of Material Engineering, Fujian Agriculture and Forestry University, Fuzhou, 350002, P. R. China.
| | - Judun Zheng
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, P. R. China.
| | - Yuhui Liao
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, P. R. China.
- NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Key Laboratory of Vascular Injury and Repair Research, Ningxia Medical University, Yinchuan, 750004, P. R. China
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10
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Gong W, Qiu S, Zheng S, Liu W, Zhang C. 68Ga-FAPI PET/CT Imaging of Intracranial Syphilitic Gumma: Comparison to 18F-FDG PET/CT. Clin Nucl Med 2023; 48:273-275. [PMID: 36723888 DOI: 10.1097/rlu.0000000000004479] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
ABSTRACT Intracranial syphilitic gumma is a rare neurological disease. We present 68Ga-DOTA-FAPI-04 and 18F-FDG PET/CT findings of intracranial syphilitic gumma in a 46-year-old man with HIV. In this case, 68Ga-DOTA-FAPI-04 PET/CT outperforms 18F-FDG in helping to visualizing syphilitic gumma. Syphilitic gumma can also cause increase FAPI activity. Our findings suggest the potential value of 68Ga-DOTA-FAPI-04 in the diagnosis of syphilis.
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Affiliation(s)
- Weidong Gong
- From the Department of Nuclear Medicine, The No. 2 People's Hospital of Yibin, Yibin
| | | | - Shiyu Zheng
- From the Department of Nuclear Medicine, The No. 2 People's Hospital of Yibin, Yibin
| | - Wei Liu
- From the Department of Nuclear Medicine, The No. 2 People's Hospital of Yibin, Yibin
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11
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Whiting C, Schwartzman G, Khachemoune A. Syphilis in Dermatology: Recognition and Management. Am J Clin Dermatol 2023; 24:287-297. [PMID: 36689103 PMCID: PMC9869822 DOI: 10.1007/s40257-022-00755-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 01/24/2023]
Abstract
The incidence of syphilis has been increasing in the USA since 2000. Notably, the coronavirus disease 2019 pandemic negatively impacted the public health efforts to contain the spread of sexually transmitted diseases including syphilis and congenital syphilis. Clinical manifestations of syphilis are predominantly mucocutaneous lesions, thus dermatologists are primed to recognize the myriad presentations of this disease. Primary syphilis is classically characterized by a painless transient chancre most often located in the genital area. Secondary syphilis typically manifests clinically as systemic symptoms in addition to a mucocutaneous eruption of which a variety of forms exist. Although less common in the era of effective penicillin treatment, late clinical manifestations of syphilis are described as well. In addition to recognition of syphilis on physical examination, several diagnostic tools may be used to confirm infection. Treponema pallidum spirochetes may be detected directly using histopathologic staining, darkfield microscopy, direct fluorescent antibody, and polymerase chain reaction assays. A table detailing the histopathologic features of syphilis is included in this article. Serologic testing, non-treponemal and treponemal tests, is the preferred method for screening and diagnosing syphilis infections. Two serologic testing algorithms exist to aid clinicians in diagnosing positive syphilis infection. Determining the correct stage of syphilis infection combines results of serologic tests, patient history, and physical examination findings. Using the current Centers for Disease Control and Prevention case definitions and treatment guidelines, a management algorithm is proposed here. Penicillin remains the pharmacological treatment of choice although specific clinical situations allow for alternative therapies. Syphilis is a reportable disease in every state and should be reported by stage according to individual state requirements. Screening recommendations are largely based upon risks encountered through sexual exposures. Likewise, sexual partner management includes evaluating and treating persons exposed to someone diagnosed with an infective stage of syphilis. Close clinical follow-up and repeat testing are recommended to ensure appropriate response to treatment. This guide will discuss the current epidemiology of syphilis and focus on practice aspects of diagnosis and management, including public health reporting.
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Affiliation(s)
- Cleo Whiting
- grid.253615.60000 0004 1936 9510School of Medicine and Health Sciences, George Washington University, Washington, DC USA
| | - Gabrielle Schwartzman
- grid.253615.60000 0004 1936 9510School of Medicine and Health Sciences, George Washington University, Washington, DC USA
| | - Amor Khachemoune
- Department of Dermatology, Veterans Affairs Medical Center, State University of New York Downstate, 800 Poly Place, Brooklyn, NY, 11209, USA. .,Department of Dermatology, Veterans Health Administration, Brooklyn, NY, USA.
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Ramírez-Amador V, Castillejos-García I, Maldonado-Mendoza J, Saeb-Lima M, Aguilar-León D, Anaya-Saavedra G. Exposing the Great Imitator: Proposal for a Holistic Diagnosis of Oral Secondary Syphilis in People Living with HIV. Head Neck Pathol 2022; 16:773-784. [PMID: 35334094 PMCID: PMC9424447 DOI: 10.1007/s12105-022-01446-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/05/2022] [Indexed: 10/18/2022]
Abstract
Oral secondary syphilis may mimic various infectious, neoplastic, or immune-mediated processes; hence, its diagnosis may represent a challenge. Early diagnosis of syphilis, a disease that has increased in recent decades, is essential for adequate management, particularly in people living with HIV (PLWH). This study aimed to comprehensively characterize oral secondary syphilis in a group of 47 PLWH. A group of PLWH with oral secondary syphilis attending four HIV-referral centers in Mexico City was included (2004-2021). Clinical and laboratory data were retrieved, and an exhaustive oral examination was performed following the established criteria. Demographic, clinicopathological, immunohistochemical, and serological features of the patients were analyzed. Approximately 11% of PLWH with oral secondary syphilis demonstrated negative Venereal Disease Research Laboratory tests. A noticeable feature was the absence of symptoms in 95.7% of cases, despite the clinically evident appearance of the lesions. In contrast to previous results, 18% of ulcerations were detected to be deep, crateriform, and infiltrative, and 22% of the mucous patches were highly keratotic lesions. Most samples (77.3%) showed superficial lymphoplasmacytic infiltrates in the superficial lamina propria, with perivascular and perineural patterns, and immunohistochemistry was positive in 66.7% of the cases. The "great imitator" appears not only clinically but also histopathologically and immunohistochemically, where features may be comparable with those of chronic inflammatory processes, deep infections, or malignant processes. Although not recommended as a routine assay, IHC could be a critical tool, particularly in PLWH with atypical clinical features or with negative and/or dubious serology.
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Affiliation(s)
- Velia Ramírez-Amador
- Oral Pathology and Medicine Master, Health Care Department, Autonomous Metropolitan University, Calzada del Hueso 1100, col. Villa Quietud, 04960, Mexico City, Mexico
| | - Itzel Castillejos-García
- Oral Pathology and Medicine Master, Health Care Department, Autonomous Metropolitan University, Calzada del Hueso 1100, col. Villa Quietud, 04960, Mexico City, Mexico
| | - Jessica Maldonado-Mendoza
- Oral Pathology and Medicine Master, Health Care Department, Autonomous Metropolitan University, Calzada del Hueso 1100, col. Villa Quietud, 04960, Mexico City, Mexico
| | - Marcela Saeb-Lima
- Pathology Department, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Diana Aguilar-León
- Pathology Department, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Gabriela Anaya-Saavedra
- Oral Pathology and Medicine Master, Health Care Department, Autonomous Metropolitan University, Calzada del Hueso 1100, col. Villa Quietud, 04960, Mexico City, Mexico.
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13
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Shakshouk H, Erickson LA, Johnson EF, Lehman JS. Updates and Proposed Diagnostic Approach to Psoriasiform Dermatoses. Adv Anat Pathol 2022; 29:263-274. [PMID: 35180737 DOI: 10.1097/pap.0000000000000333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Psoriasiform dermatoses represent a wide array of skin diseases commonly encountered by clinicians and pathologists. While they may present a diagnostic challenge, thorough observation coupled with proper interpretation of subtle additional clinical or histopathologic features provide clues to the correct diagnosis. In this review, we provide updates on emerging entities and develop a systemic approach to establish the pathologic diagnosis, with emphasis on the importance of clinicopathologic correlation.
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Affiliation(s)
- Hadir Shakshouk
- Departments of Dermatology
- Department of Dermatology, Alexandria University, Alexandria, Egypt
| | - Lori A Erickson
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Emma F Johnson
- Departments of Dermatology
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Julia S Lehman
- Departments of Dermatology
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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14
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Khalil S, Donthi D, Gru AA. Cutaneous Reactive B-cell Lymphoid Proliferations. J Cutan Pathol 2022; 49:898-916. [PMID: 35656820 DOI: 10.1111/cup.14264] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 05/14/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
Abstract
Cutaneous lymphoid hyperplasia (CLH), also known as cutaneous pseudolymphoma, is a spectrum of benign conditions characterized by reactive B- and T-cell cutaneous lymphocytic infiltrates. B-cell lymphoid proliferations are a heterogenous group of non-neoplastic cutaneous diseases that must be histopathologically distinguished from cutaneous B-cell lymphomas. These proliferations can be observed as reactive phenomena to infections, medications, allergens, neoplasms, and more. Further, there are many inflammatory conditions that present with reactive B-cell infiltrates, including actinic prurigo, Zoon balanitis, Rosai-Dorfman, and cutaneous plasmacytosis. This review summarizes multiple cutaneous B-cell lymphoid proliferations within the major categories of reactive and disease-associated CLH. Further we discuss major discriminating features of atypical CLH and malignancy. Understanding the specific patterns of B-cell CLH is essential for the proper diagnosis and treatment of patients presenting with such lesions.
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Affiliation(s)
- Shadi Khalil
- Department of Dermatology, University of California San Diego
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15
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Balaban A, Al-Rohil RN. A Case of Congenital Syphilis-Focus on Histopathology and Literature Review. Am J Dermatopathol 2022; 44:372-375. [PMID: 35120035 DOI: 10.1097/dad.0000000000002055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Although a rare disease, the incidence of congenital syphilis is on the rise in the US. We report a case of early congenital syphilis in a 1-day-old premature boy with positive Rapid plasma reagin titer, respiratory insufficiency, disseminated intravascular coagulation, and encephalopathy, born to a mother with known syphilis infection. Skin examination showed diffuse truncal petechiae, desquamation of the distal extremities, and violaceous, retiform plaques on the buttocks and lower extremities. A biopsy was performed to rule out an infectious etiology or vasculitis. Histopathologic examination revealed irregular epidermal acanthosis with orthokeratosis and parakeratosis. There were foci of neutrophilic infiltrate forming rare pustules within the stratum corneum and focal intraepidermal eosinophils, neutrophils, and rare dyskeratotic keratinocytes. In the dermis, there was some minimal endothelial swelling with a perivascular, interstitial, and periadnexal infiltrate of lymphocytes, eosinophils, and rare plasma cells. A Treponema pallidum immunostain highlighted spirochetes present within the epidermis and within the eccrine ducts. Penicillin G therapy was administered for 10 days. The infant's Rapid plasma reagin titer trended downward until it was negative 6 months after birth. Literature review reveals 8 case reports within the last 20 years describing the histopathology of rashes in congenital syphilis. Herein we summarize the reported histopathology of rashes in congenital syphilis and compare it to the histopathology of rashes in secondary syphilis in adults.
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Affiliation(s)
- Alexandra Balaban
- Department of Pathology, Duke University School of Medicine, DUMC 3712, Durham, NC
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Xie B, Zhao T, Zhao S, Zhou J, Zhao F. Possible effects of Treponema pallidum infection on human vascular endothelial cells. J Clin Lab Anal 2022; 36:e24318. [PMID: 35274369 PMCID: PMC8993650 DOI: 10.1002/jcla.24318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/18/2022] [Accepted: 02/12/2022] [Indexed: 11/06/2022] Open
Abstract
Pathogens can affect host cells in various ways, and the same effect can be found in the Treponema pallidum acting on the endothelium of host vessels, and the mechanism is often complex and multiple. Based on the existing T. pallidum of a cognitive framework, the first concerns involving T. pallidum or the bacteria protein directly acted on vascular endothelial cells of the host, the second concerns mainly involved in the process of T. pallidum infection in vivo blood lipid change, secretion of cytokines and the interactions between immune cells indirectly. Through both direct and indirect influence, this study explores the role of host by T. pallidum infect in the process of the vascular endothelium.
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Affiliation(s)
- Bibo Xie
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan ProvinceHengyang Medical CollegeUniversity of South ChinaHengyangP.R. China
| | - Tie Zhao
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan ProvinceHengyang Medical CollegeUniversity of South ChinaHengyangP.R. China
| | - Sisi Zhao
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan ProvinceHengyang Medical CollegeUniversity of South ChinaHengyangP.R. China
| | - Jie Zhou
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan ProvinceHengyang Medical CollegeUniversity of South ChinaHengyangP.R. China
| | - Feijun Zhao
- Institute of Pathogenic Biology and Key Laboratory of Special Pathogen Prevention and Control of Hunan ProvinceHengyang Medical CollegeUniversity of South ChinaHengyangP.R. China
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17
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Schettini AP, Sardinha JC, Marques EA, Massone C. Psoriasiform syphilis: A challenge. Dermatol Reports 2021; 13:8830. [PMID: 35035804 PMCID: PMC8696190 DOI: 10.4081/dr.2021.8830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 07/11/2021] [Indexed: 11/23/2022] Open
Abstract
Syphilis is one of the greatest masqueraders in dermatology, like mycosis fungoides or sarcoidosis. In fact, secondary syphilis can simulate different dermatological conditions, not only clinically but also histopathologically. A 34-year-old Brazilian man from Manaus (Amazonas) attended our Department complaining for 2 weeks of asthenia, weight loss and multiple asymptomatic disseminated erythematous papules and scaly plaques with well-defined borders and a tendency to confluence were observed on the trunk, neck and extremities, clinically similar to psoriasis guttata. The skin biopsy and laboratory tests disclosed secondary syphilis and the patient was treated with intramuscular benzathine penicillin with prednisolone, with a complete resolution. Psoriasiform syphilis, which imitates psoriasis, was well known by old dermatologists and was called syphilide psoriasiforme or psoriasis syphilitique. Psoriasiform syphilis is one of the atypical presentations of secondary syphilis and dermatologists should be aware of psoriasiform syphilis in order not to improperly treat syphilis patients with immunosuppressive drugs; also, pathologists should be aware of secondary syphilis histopathological features.
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18
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Hermann N, Binkert A, Kolm I. Disseminated ulcerated nodules, unilateral tonsillitis, and malaise. Int J Dermatol 2021; 61:e4-e5. [PMID: 34751957 DOI: 10.1111/ijd.15904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/08/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Nicola Hermann
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andrea Binkert
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Isabel Kolm
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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19
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Yi LG, Rusu CA, Cropley TG, Marchi E, Gru AA, Greer KE, Raghavan SS. Clonal cutaneous and neurosyphilis: A pitfall in pseudolymphoma diagnosis. J Cutan Pathol 2021; 49:288-292. [PMID: 34655438 DOI: 10.1111/cup.14153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/18/2021] [Accepted: 10/11/2021] [Indexed: 11/28/2022]
Abstract
Syphilis is a sexually transmitted infectious disease caused by the bacterium Treponema pallidum and can cause a wide variety of cutaneous manifestations, most commonly, a papulosquamous eruption of the trunk and extremities. Treatment with penicillin is curative. We report a case of a 69-year-old man who presented with recent onset of blurry vision and a nonpainful, nonpruritic eruption of pink-to-violaceous dermal nodules on his upper trunk and upper extremities. Biopsies of two separate locations revealed a dense superficial and deep perivascular atypical lymphocytic infiltrate with admixed plasma cells, histiocytes, and eosinophils. Some scattered cells expressed CD30, PD1, BCL-6, and ICOS. T-cell receptor (TCR)-rearrangement showed an identical TCR-gamma clone between both biopsy specimens. The patient was subsequently seen by ophthalmology and diagnosed with acute anterior uveitis. Rapid plasma reagin was reactive and cerebrospinal fluid studies showed findings consistent with a diagnosis of neurosyphilis. A T. pallidum immunostain of the skin biopsies was performed upon re-review, and was diffusely positive for spirochetes at the dermal-epidermal junction and within injured vessels. The patient was treated with penicillin G with near-resolution of his skin lesions. This case highlights the unusual ability of syphilis to mimic a T-cell lymphoma with matching clones across two different biopsy sites.
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Affiliation(s)
- Lauren G Yi
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Corina A Rusu
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Thomas G Cropley
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Enrica Marchi
- Department of Medicine, Division of Hematology & Oncology, University of Virginia Cancer Center, Charlottesville, Virginia, USA
| | - Alejandro A Gru
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Kenneth E Greer
- Department of Dermatology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Shyam S Raghavan
- Department of Pathology, University of Virginia Health System, Charlottesville, Virginia, USA
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20
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Zhang M, Yu J, Huang H, Zhou C, Zhai Z, You Y, Song Z. Secondary Syphilis in a 12-Year-Old Girl Misdiagnosed as Pityriasis lichenoides et varioliformis acuta: A Case Report. Clin Cosmet Investig Dermatol 2021; 14:815-820. [PMID: 34262318 PMCID: PMC8275113 DOI: 10.2147/ccid.s315235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/11/2021] [Indexed: 12/03/2022]
Abstract
Syphilis is a complex, systemic infectious disease caused by Treponema pallidum subspecies pallidum. Herein, we report a rare case of secondary syphilis with probable neurosyphilis that was misdiagnosed as pityriasis lichenoides et varioliformis acuta (PLEVA) in a 12-year-old human immunodeficiency virus (HIV) negative patient. A female patient presented to our hospital with a four-month history of relapsed systemic rash, accompanied by hair loss, arthralgia and fatigue. Based on physical examination and skin biopsy, she was initially diagnosed as PLEVA and treated both locally and systemically but failed to present a dermatologic improvement. The diagnosis of secondary syphilis with probable neurosyphilis was made based on serologic and cerebrospinal fluid tests. After neurosyphilis therapy, the clinical manifestations of the patient were significantly improved. Physicians should be alert for the possibility of syphilis when encountering cases with unusual clinical manifestations.
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Affiliation(s)
- Min Zhang
- Department of Dermatology and Venereology, The First Affiliated Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Jia Yu
- Department of Dermatology, Distinct HealthCare, Chongqing, People's Republic of China
| | - Hui Huang
- Department of Dermatology and Venereology, The First Affiliated Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Cunjian Zhou
- Department of Dermatology and Venereology, The First Affiliated Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Zhifang Zhai
- Department of Dermatology and Venereology, The First Affiliated Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Yi You
- Department of Dermatology and Venereology, The First Affiliated Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Zhiqiang Song
- Department of Dermatology and Venereology, The First Affiliated Hospital, Army Medical University, Chongqing, People's Republic of China
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21
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Trinh NB, Wu YH, Hieu HT. Penile annular secondary syphilis mimicking annular lichen planus. Int J Dermatol 2021; 61:e115-e116. [PMID: 34151427 DOI: 10.1111/ijd.15703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/08/2021] [Accepted: 05/25/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Ngo Binh Trinh
- Department of Venereology, Ho Chi Minh City Hospital of Dermato-Venereology, Ho Chi Minh City, Vietnam
| | - Yu-Hung Wu
- Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hoang Trung Hieu
- Department of Dermatology, Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
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22
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Ortonne N. [Interface dermatitis, a pattern seen a wide range of dermatological diseases. Case No. 5]. Ann Pathol 2021; 41:271-275. [PMID: 33741196 DOI: 10.1016/j.annpat.2021.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Nicolas Ortonne
- Département de pathologie, hôpital Henri-Mondor, université Paris Est Créteil (UPEC), Assistance publique des Hôpitaux de Paris (AP-HP), Créteil, France.
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23
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Henebeng E, Karasko E, Robinson-Bostom L, DiMarco C. Secondary Syphilis With Elastophagocytosis: An Unusual Histologic Finding. Am J Dermatopathol 2021; 43:225-227. [PMID: 33298710 DOI: 10.1097/dad.0000000000001832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Elastophagocytosis is a characteristic finding of granulomatous and elastolytic disorders. It is defined by phagocytosed elastic fibers within histiocytes, multinucleated giant cells, or both. This finding has also been associated with certain medications, malignancies, inflammatory conditions, and infectious disorders. Although Drs Ragaz and Ackerman reported elastophagocytosis in a secondary syphilis lesion in a review of actinic granuloma in 1979, more recent publications have not recognized this finding. We present a case of elastophagocytosis within a lesion of secondary syphilis in a 65-year-old man. Biopsy from his left forearm demonstrated features of secondary syphilis including subtle vacuolar alteration with mild superficial and mid perivascular lymphoplasmacytic inflammation. There were interstitial giant cells with phagocytosed elastic fibers within the superficial dermis. Spirochete immunostain was positive with confirmatory Treponema pallidum IgG antibody and RPR titer. In this report, we present a unique case of secondary syphilis.
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Affiliation(s)
- Esther Henebeng
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, RI; and
| | - Erich Karasko
- Department of Dermatology, Brown Dermatology, Providence, RI
| | - Leslie Robinson-Bostom
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, RI; and
- Department of Dermatology, Brown Dermatology, Providence, RI
| | - Christopher DiMarco
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, RI; and
- Department of Dermatology, Brown Dermatology, Providence, RI
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24
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Aung PP, Wimmer DB, Lester TR, Tetzlaff MT, Prieto VG. Perianal condylomata lata mimicking carcinoma. J Cutan Pathol 2021; 49:209-214. [PMID: 33470447 DOI: 10.1111/cup.13865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/25/2020] [Accepted: 09/01/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel B Wimmer
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Todd R Lester
- Department of Pathology, CHI St. Luke's Health, Houston, Texas, USA
| | - Michael T Tetzlaff
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Victor G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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25
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Smith MH, Vargo RJ, Bilodeau EA, Anderson KM, Trzcinska A, Canterbury CR, Fantasia JE, Rawal YB. Oral Manifestations of Syphilis: a Review of the Clinical and Histopathologic Characteristics of a Reemerging Entity with Report of 19 New Cases. Head Neck Pathol 2021; 15:787-795. [PMID: 33459991 PMCID: PMC8384985 DOI: 10.1007/s12105-020-01283-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Syphilis is a sexually-transmitted infectious disease caused by Treponema pallidum. Cases of primary and secondary syphilis are on the rise in the United States, with a 14.4% increase in new cases noted from 2017 to 2018 and an escalation of 71% between the years 2014 and 2018. Fulfilling its nickname of "the great imitator," oral manifestations of syphilis may mimic a variety of infectious, neoplastic, or immune-mediated processes, both clinically and histopathologically. This large spectrum of appearances can create a diagnostic challenge to the clinician and/or pathologist, leading to delay in diagnosis or misdiagnosis. METHODS A database of oral syphilis cases was created from archives at the University of Kentucky, University of Pittsburgh, LIJMC, Columbia University MC, and University of Tennessee. The age, sex, race, location, duration, and clinical description were recorded. Cases without positive reaction upon immunohistochemistry or serologic tests were excluded. RESULTS We identified 19 new cases of oral syphilis (17 males, one female, and one case unknown sex) and described the clinical and histopathological features of this re-emerging and potentially fatal disease. All cases demonstrated dense lymphoplasmacytic inflammation, often with inflammatory exocytosis or ulceration at the surface, and perivascular inflammation. CONCLUSIONS Early recognition of the histopathologic and clinical manifestations of oral syphilis is imperative for prompt diagnosis, improved patient outcomes, and disease prevention.
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Affiliation(s)
- Molly Housley Smith
- Division of Oral and Maxillofacial Pathology, University of Kentucky College of Dentistry, 800 Rose Street, Rm. 530, Lexington, KY, 40536, USA.
| | - Richard J Vargo
- Oral and Maxillofacial Pathology Specialty Care Unit, A.T. Still University-Missouri School of Dentistry & Oral Health, St. Louis, MO, USA
| | - Elizabeth Ann Bilodeau
- Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, G-135 Salk Hall, 3501 Terrace St., Pittsburgh, PA, USA
| | - K Mark Anderson
- Department of Diagnostic Sciences, The University of Tennessee College of Dentistry, Memphis, TN, USA
| | - Anna Trzcinska
- Head and Neck Pathology Fellow, Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Carleigh R Canterbury
- Division of Oral and Maxillofacial Pathology, Columbia University Medical Center, New York, NY, USA
| | - John E Fantasia
- Department of Dental Medicine, Division of Oral and Maxillofacial Pathology, Long Island Jewish Medical Center, Zucker School of Medicine At Hofstra Northwell Health, New Hyde Park, NY, USA
| | - Yeshwant B Rawal
- Department of Surgical Sciences, Marquette University School of Dentistry, Milwaukee, WI, USA
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26
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Abstract
Syphilis is a sexually transmitted disease caused by the spirochetal bacterium Treponema pallidum that has been of public health concern for centuries. In the United States, it is currently a reportable disease and one which is recently generating increasing case numbers especially in at risk populations of immune deficiency and men who have sex with men. The present series examines biopsies from 13 patients collected over a 12-year period from a general hospital network in north suburban Cook County, Illinois. There were 13 patients (11 male: 2 female) with varied presentations, including primary ulcerated anogenital chancres, mucosal lesions, peculiar rashes, and alopecia. The reason(s) for biopsy were not clear from the clinical record, as a clinical consideration of syphilis was recorded in only 3 cases. Histologic examination of the mucocutaneous lesions encompassed a spectrum of findings including ulceration, psoriasiform hyperplasia, intense mixed band-like inflammation at the dermal-epidermal junction with a prominent plasma cell component. The contemporary availability of an effective immunostain is a valuable diagnostic adjunct. The organisms generally parallel the intensity of the inflammatory infiltrate but the distribution may vary and rarely, organisms may be absent despite serologic confirmation. Previous corkscrew morphology of the organism described ultrastructurally is reflected in the immunostained representation. Although the diagnosis of syphilis remains a clinical one in most cases, some patients will have unusual presentations and biopsies will be done. The awareness of the pathologist will facilitate prompt and effective treatment.
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27
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Zare SY. Infectious disorders of the vulva. Semin Diagn Pathol 2020; 38:19-26. [PMID: 33067080 DOI: 10.1053/j.semdp.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 11/11/2022]
Abstract
The vulva can be affected by a variety of sexually transmitted infections as well as other common infections that are not typically related to sexual transmission. Vulvar infections may adversely affect the quality of life of the patients by causing discomfort and pain. Some of these infections, especially the ulcerative ones, may also increase the risk of transmission of other infectious diseases, including HIV. Due to the recently increasing number of sexually transmitted infections and atypical presentations of these infections in immunocompromised patients, it is important for pathologists to be familiar with histopathologic features of the infectious diseases of the vulva, so that accurate diagnoses can be rendered as promptly as possible. This review discusses the clinicopathologic presentations of the non-HPV related infections of the vulva.
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Affiliation(s)
- Somaye Y Zare
- Department of Pathology, University of California San Diego, La Jolla, CA, USA.
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28
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Wu J, Chen H, Long FQ. A solitary annular plaque on the jaw: atypical presentation of secondary syphilis. Chin Med J (Engl) 2020; 133:1383-1384. [PMID: 32345826 PMCID: PMC7289309 DOI: 10.1097/cm9.0000000000000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Juan Wu
- Department of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai 200443, China
| | - Hao Chen
- Department of Pathology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu 210042, China
| | - Fu-Quan Long
- Department of Sexually Transmitted Disease, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai 200443, China
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29
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Comment on "Histopathologic features distinguishing secondary syphilis from its mimickers". J Am Acad Dermatol 2020; 83:e135. [PMID: 32278806 DOI: 10.1016/j.jaad.2020.03.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 11/20/2022]
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30
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Fernandez-Nieto D, Ortega-Quijano D, Jimenez-Cauhe J, Fernandez-Gonzalez P, Moreno-Moreno E, Bea-Ardebol S. Secondary syphilis mimicking tuberculoid leprosy in an HIV-positive individual: a case report. Int J STD AIDS 2019; 30:1235-1238. [PMID: 31558132 DOI: 10.1177/0956462419869136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Secondary syphilis is a polymorphic condition resulting from the hematogenous and lymphatic dissemination of Treponema pallidum. Human immunodeficiency virus-positive patients are in greater risk of atypical and severe forms of the disease. The most common manifestation is a generalized papulosquamous eruption with variable mucosal involvement. However, annular plaques, split commissural papules, crusted necrotic or ulcerated lesions are also frequent. Granulomatous lesions, both clinically and histologically, are less common and present a diagnostic challenge. We describe a case of secondary syphilis presenting as a granulomatous rash with both clinical and histological features of tuberculoid leprosy. Complementary tests and clinical suspicion are essential to ensure a correct diagnosis and avoid subsequent complications.
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Affiliation(s)
- D Fernandez-Nieto
- Department of Dermatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - D Ortega-Quijano
- Department of Dermatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J Jimenez-Cauhe
- Department of Dermatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - E Moreno-Moreno
- Department of Pathology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - S Bea-Ardebol
- Department of Dermatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
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31
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Liu XK, Li J. Histologic Features of Secondary Syphilis. Dermatology 2019; 236:145-150. [PMID: 31536976 DOI: 10.1159/000502641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/11/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Secondary syphilis is a sexually transmitted infection, which is referred to as "the great imitator" and has a wide spectrum of clinical manifestations. As a result, it is essential to identify potential secondary syphilis patients with ambiguous clinical manifestation through pathology. OBJECTIVE We sought to analyze the pathological features of secondary syphilis. METHODS We analyzed 59 biopsy specimens from 56 patients with secondary syphilis. Cases were classified according to the histological characteristics and clinical features. RESULTS Necrotic keratinocytes could be observed in 39 of 59 (66.1%) secondary specimens. Plasma cells (86.4%) were the most common finding overall. The presence of Treponema pallidum was detected mostly at the dermal-epidermal junction. There was no statistical significance between pathological features and age, HIV status, or RPR titer. CONCLUSIONS Necrotic keratinocytes are one of the characteristics of secondary syphilis. The combination of plasma cells, irregular acanthosis, elongated rete ridges, and endothelial swelling should increase the likelihood of syphilis.
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Affiliation(s)
- Xiao Ke Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Li
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,
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32
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Mitteldorf C, Kempf W. Cutaneous pseudolymphoma—A review on the spectrum and a proposal for a new classification. J Cutan Pathol 2019; 47:76-97. [DOI: 10.1111/cup.13532] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/26/2019] [Accepted: 06/14/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Christina Mitteldorf
- Department of Dermatology, Venereology and AllergologyUniversity Medical Center Göttingen Germany
| | - Werner Kempf
- Kempf und Pfaltz, Histologische Diagnostik Zürich Switzerland
- Department of DermatologyUniversity Hospital Zurich Zurich Switzerland
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33
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Flamm A, Alcocer VM, Kazlouskaya V, Kwon EJ, Elston D. Histopathologic features distinguishing secondary syphilis from its mimickers. J Am Acad Dermatol 2019; 82:156-160. [PMID: 31306731 DOI: 10.1016/j.jaad.2019.07.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/30/2019] [Accepted: 07/08/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Syphilis is often misdiagnosed clinically, and biopsies might be required. OBJECTIVE To determine histopathologic features that distinguish secondary syphilis from pityriasis lichenoides (PL), pityriasis rosea (PR), and early mycosis fungoides (MF). METHODS Histopathologic features of 100 cases of syphilis, 110 cases of PL, 72 cases of PR, and 101 cases of MF were compared. RESULTS Elongated rete ridges and interstitial inflammation favor syphilis over PL (likelihood ratios 3.44 and 2.72, respectively), but no feature reliably distinguishes between them. Secondary syphilis and PR can be distinguished by neutrophils in the stratum corneum, plasma cells, interface dermatitis with lymphocytes and vacuoles, and lymphocytes with ample cytoplasm. Plasma cells and lymphocytes with ample cytoplasm are rare in early MF and can be used as distinguishing features. CONCLUSIONS Histopathologic features characteristic of syphilis can be seen in PL, PR, and early MF. Distinguishing syphilis from PL can be difficult histologically, and a high index of suspicion is required. Although elongation of rete and interstitial inflammation favor syphilis, plasma cells (historically considered a significant feature of syphilis) are often encountered in PL. Vacuolar interface dermatitis with a lymphocyte in every vacuole is considered characteristic of PL, but this feature appears to be more common in syphilis.
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Affiliation(s)
- Alexandra Flamm
- Department of Pathology and Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania.
| | - Veronica Merelo Alcocer
- Department of Pathology and Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | | | - Eun Ji Kwon
- Dermpath Diagnostics New York, Port Chester, New York
| | - Dirk Elston
- Department of Dermatology, University of South Carolina, Charleston, South Carolina
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Ambooken B, Asokan N, Jisha KT, Ninan L. Syphilis cornee mimicking lichen planus clinically and histologically. Indian J Sex Transm Dis AIDS 2019; 39:130-132. [PMID: 30623186 PMCID: PMC6298153 DOI: 10.4103/ijstd.ijstd_15_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Palmoplantar lesions of secondary syphilis are often termed “syphilis cornee.” A 32-year-old male presented with itchy lichenoid papules on both soles and left palm associated with grayish white papules on the buccal mucosa and glans penis. Initial clinical diagnosis of palmoplantar lichen planus with mucosal involvement was supported by the histopathological finding of interface dermatitis. However, more detailed history, serological tests of syphilis, and review of histopathological findings led us to revise the diagnosis as syphilis cornee. This case highlights the uncommon presentation of syphilis cornee as pruritic palmoplantar lichenoid papules with histology showing interface dermatitis. A high index of clinical suspicion of secondary syphilis is needed as its manifestations are often deceptive.
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Affiliation(s)
- Betsy Ambooken
- Department of Dermatology and Venereology, Government Medical College, Thrissur, Kerala, India
| | - Neelakandhan Asokan
- Department of Dermatology and Venereology, Government Medical College, Thrissur, Kerala, India
| | - K T Jisha
- Department of Pathology, Government Medical College, Thrissur, Kerala, India
| | - Lincy Ninan
- Department of Dermatology and Venereology, Government Medical College, Thrissur, Kerala, India
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Abstract
Inflammatory skin diseases encompass a vast array of conditions. The field continues to expand and evolve with resurgence of conditions, through newly recognized medication adverse effects, and via more detailed descriptions of known dermatoses. The importance of clinicopathologic correlation and an up to date knowledge of dermatologic conditions cannot be overstated. This review focuses on an array of recent important developments in the histologic diagnosis of inflammatory conditions that affect the skin.
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Mitteldorf C, Plumbaum H, Zutt M, Schön MP, Kaune KM. CD8‐positive pseudolymphoma in lues maligna and human immunodeficiency virus with monoclonal T‐cell receptor‐beta rearrangement. J Cutan Pathol 2018; 46:204-210. [DOI: 10.1111/cup.13390] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/27/2018] [Accepted: 11/05/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Christina Mitteldorf
- Department of Dermatology, Venereology and AllergologyUniversity Medical Centre Göttingen Göttingen Germany
| | - Heidi Plumbaum
- Department of PathologyKlinikum Bremen‐Mitte Bremen Germany
| | - Markus Zutt
- Department of Dermatology and AllergologyKlinikum Bremen‐Mitte Bremen Germany
| | - Michael P. Schön
- Department of Dermatology, Venereology and AllergologyUniversity Medical Centre Göttingen Göttingen Germany
| | - Kjell M. Kaune
- Department of Dermatology and AllergologyKlinikum Bremen‐Mitte Bremen Germany
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Genovese G, Nazzaro G, Coggi A, Gianotti R, Ramoni S, Cusini M. Secondary syphilis masquerading as lupus vulgaris in an HIV-infected patient: A diagnosis suggested by histology. Int J STD AIDS 2018; 29:1454-1456. [PMID: 30170530 DOI: 10.1177/0956462418795590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a case of secondary syphilis mimicking lupus vulgaris in an HIV-infected patient. A 21-year-old Brazilian man presented with a two-month history of asymptomatic cutaneous lesions accompanied by fever and fatigue. Dermatological evaluation revealed an erythematous, crusted, large plaque on the neck with the 'apple jelly' sign on diascopy and two smaller scaly elements on the trunk and left palm. Bacteriological examinations for bacteria and mycobacteria gave negative results. Histology revealed psoriasiform epidermal hyperplasia and dermal lymphoplasmacytic infiltrate. Serology for syphilis was positive, and immunohistochemistry confirmed the presence of Treponema pallidum in lesional skin. A diagnosis of secondary syphilis was made, and the patient was successfully treated with benzathine penicillin G. Cutaneous manifestations of secondary syphilis are protean and skin tuberculosis may be considered in the differential diagnosis, especially in HIV-infected patients. In the current case, clinical examination, and particularly, 'apple jelly' sign positivity, was suggestive of lupus vulgaris, but only typical histopathology and immunohistochemistry led to the correct diagnosis of secondary syphilis.
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Affiliation(s)
- Giovanni Genovese
- Dermatology Unit, Department of Physiopathology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluca Nazzaro
- Dermatology Unit, Department of Physiopathology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonella Coggi
- Dermatology Unit, Department of Physiopathology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Raffaele Gianotti
- Dermatology Unit, Department of Physiopathology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Ramoni
- Dermatology Unit, Department of Physiopathology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Cusini
- Dermatology Unit, Department of Physiopathology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Abstract
Owing to the wide variety and complexity of inflammatory skin diseases, inflammatory dermatopathology can be a challenging topic for dermatopathologists and general surgical pathologists alike. Following a basic tissue reaction pattern approach, this article reviews the most common and important entities of each pattern, with emphasis on differential diagnosis, diagnostic pitfalls, and appropriate workup when indicated. A few dermatologic emergencies are also discussed.
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Singh R, Teranno D. Unusual presentation of a skin rash. J Clin Pathol 2017; 70:1088. [PMID: 28416641 PMCID: PMC5749349 DOI: 10.1136/jclinpath-2016-204007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/09/2017] [Accepted: 02/17/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Rajendra Singh
- Department of Pathology and Laboratory Medicine, The Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David Teranno
- Department of Pathology and Laboratory Medicine, The Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Gottesman SP, Schoenling YS, Culpepper KS. Late latent mucinous syphilis mimicking connective tissue disease. J Cutan Pathol 2017; 44:578-581. [PMID: 28244118 DOI: 10.1111/cup.12924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/17/2017] [Accepted: 02/23/2017] [Indexed: 11/28/2022]
Abstract
As evidenced by the Centers for Disease Control and Prevention (CDC) statistics, syphilis is yet again on the rise. It is known as the great mimicker because of its variable symptoms and how frequently it can be confused with other diseases. The different stages of syphilis (primary, secondary, latent, late latent and tertiary) are discussed. We describe a new histopathologic pattern of syphilis, one that mimics connective tissue disease and can represent a diagnostic pitfall. In this time and age, when syphilis is rising especially among the men who have sex with men subgroup, it is important to keep a high index of suspicion of syphilis even when clinically and histopathologically the findings on first glance may not appear characteristic.
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Affiliation(s)
| | | | - Keliegh S Culpepper
- University of Arizona, Department of Medicine, Division of Dermatology, Tucson, Arizona.,Dermpath Diagnostics, Tucson, Arizona
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