1
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Lopez P, Kwentoh I, Valdez Imbert M. A Peculiar Presentation of Syphilis as a Mysterious Rash: A Dermatological Dilemma. Cureus 2023; 15:e45328. [PMID: 37720122 PMCID: PMC10504092 DOI: 10.7759/cureus.45328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 09/19/2023] Open
Abstract
A renowned poet in the ancient city of Verona by the name of Girolamo Fracastoro coined the term syphilis in 1530. The stigma and shame that embodied this affliction has been time immemorial and disabling for patients. The hypothesis of the spread from the warm tropics of west and central Africa to the Iberian Peninsula accompanied by the slave trade has been a tale for centuries. Malignant syphilis is a rare skin manifestation of Treponema pallidum infection and a variant of secondary syphilis. The rash is frequently associated with HIV-infected patients, often with low cluster differentiation 4 (CD4) cell count. The authors reported a unique case involving a 46-year-old woman who presented with a one-week history of skin eruptions at various stages. Subsequent laboratory tests revealed a strong positive result for Treponema pallidum and a positive Rapid Plasma Reagin (RPR) test with a titer of 1:16. She received doxycycline because she had a history of penicillin anaphylaxis in the past. She did well, with a remarkable improvement in symptoms - a positive outcome for this catastrophic stigmatizing, rare diagnosis.
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Affiliation(s)
- Priscila Lopez
- Internal Medicine, Harlem Hospital Center, New York, USA
| | - Ifeoma Kwentoh
- Medicine, Columbia University, New York, USA
- Internal Medicine, Harlem Hospital Center, New York, USA
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2
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Karanfilian KM, Almohssen AA, Kapila R, Schwartz RA. Malignant syphilis: a new and revised definition. Int J Dermatol 2023; 62:369-375. [PMID: 36250867 DOI: 10.1111/ijd.16444] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 08/07/2022] [Accepted: 09/22/2022] [Indexed: 12/01/2022]
Abstract
Malignant syphilis is a rare, severe variant of secondary syphilis that primarily affects immunocompromised patients. Historically, the clinical presentation included a prodrome of constitutional symptoms followed by the development of characteristic skin lesions. The definition of malignant syphilis has not been updated since it was first described as only a cutaneous manifestation. In recent years, syphilis has reemerged as a major public health issue, particularly in men who have sex with men (MSM) and patients with HIV. With increasing rates of syphilis in the HIV-positive population, the systemic manifestations of malignant syphilis have become more apparent. We propose a revised definition and elucidate why the term malignant syphilis should be expanded to include systemic manifestations, stressing musculoskeletal, central nervous system, ocular, ear, cardiovascular, rectal, liver, lung, and renal involvement. This updated definition is dramatically expanded to reflect its systemic manifestations. Recognition of these manifestations may prevent devastating long-term effects.
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Affiliation(s)
| | | | - Rajendra Kapila
- Infectious Disease, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Robert A Schwartz
- Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, NJ, USA
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3
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Chen JQ, Cao YL, Man XY. Malignant syphilis in a young woman: A case report. J Int Med Res 2022; 50:3000605221131368. [PMID: 36217269 PMCID: PMC9558884 DOI: 10.1177/03000605221131368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Malignant syphilis (MS) is a rare dermatological manifestation of secondary syphilis. This case report describes a young woman that presented with a 15-day history of generalized condyloma lata and seborrheic dermatitis-like lesions at various stages. Laboratory tests showed a toluidine red unheated serum test titre of 1:128 and Treponema pallidum particle agglutination positivity. Serology for HIV antibodies was repeatedly negative. MS was diagnosed according to established MS diagnostic criteria. The lesions regressed after treatment with 2 400 000 units penicillin G benzathine by intramuscular injection weekly for three consecutive weeks. MS is more frequently associated with HIV-infected patients, which makes this current case more interesting because MS in HIV-negative patients has rarely been reported.
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Affiliation(s)
- Jia-Qi Chen
- Department of Dermatology, Second Affiliated
Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province,
China
| | - Yue-Lan Cao
- Department of Dermatology, Second Affiliated
Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province,
China
| | - Xiao-Yong Man
- Department of Dermatology, Second Affiliated
Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province,
China
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4
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Demirbaş A, Şikar Aktürk A, Demirsoy EO, Kıran R, Bayramgürler D, Sayman N, Açıkbaş E, Vural Ç. Lues Maligna in an immunocompetent male: A case report. J Cosmet Dermatol 2022; 21:3160-3162. [PMID: 35612931 DOI: 10.1111/jocd.15113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/20/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Abdullah Demirbaş
- Department of Dermatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Aysun Şikar Aktürk
- Department of Dermatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | | | - Rebiay Kıran
- Department of Dermatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Dilek Bayramgürler
- Department of Dermatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Nilgün Sayman
- Department of Dermatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Enes Açıkbaş
- Department of Dermatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Çiğdem Vural
- Department of Pathology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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5
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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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6
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Malignant Syphilis and Pruritic Papular Eruption in an HIV-Positive Man. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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7
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Granizo-Rubio J, Caviedes-Vallejo C, Chávez-Dávila N, Pinos-León V. Sífilis maligna y erupción papular pruriginosa en un paciente VIH positivo. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:269-271. [DOI: 10.1016/j.ad.2018.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 11/29/2022] Open
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8
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Ulcerative nodules on the entire body. JAAD Case Rep 2020; 6:76-78. [PMID: 31970281 PMCID: PMC6965204 DOI: 10.1016/j.jdcr.2019.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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9
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Wu CY, Lo CY, Liang CW, Jee SH, Chu CH. Rapidly evolving papulonecrotic eruption in a middle-aged man. Int J Dermatol 2019; 59:687-689. [PMID: 31829439 DOI: 10.1111/ijd.14733] [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: 09/24/2019] [Accepted: 11/06/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Chen-Yu Wu
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
| | - Cheng-Yu Lo
- Department of Pathology, Cathay General Hospital, Taipei, Taiwan
| | - Cher-Wei Liang
- Department of Pathology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Shiou-Hwa Jee
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan.,Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ho Chu
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan.,Department of Dermatology, Hsinchu Cathay General Hospital, Hsinchu, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
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10
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Guo H, Li JH. Rupioid syphilis. Assoc Med J 2019. [DOI: 10.1136/bmj.l5932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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11
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Sun JR, Tu P, Wang Y. Image Gallery: Malignant syphilis in a young man with HIV infection. Br J Dermatol 2019; 178:e392. [PMID: 29897123 DOI: 10.1111/bjd.16566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- J R Sun
- Department of Dermatology and Venerology, Peking University First Hospital, No. 8 Xishiku Street, Xi Cheng District, Beijing, 100034, China
| | - P Tu
- Department of Dermatology and Venerology, Peking University First Hospital, No. 8 Xishiku Street, Xi Cheng District, Beijing, 100034, China
| | - Y Wang
- Department of Dermatology and Venerology, Peking University First Hospital, No. 8 Xishiku Street, Xi Cheng District, Beijing, 100034, China
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12
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Zhu L, Shi M, Peng RR, Gu X, Guan Z, Xu H, Zhou P. Neurosyphilis is more common in malignant syphilis: A case series and review of the literature. Int J STD AIDS 2019; 30:779-785. [PMID: 31142223 DOI: 10.1177/0956462419826710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Malignant syphilis is a rare skin manifestation of secondary syphilis, which has been reported primarily in the HIV-infected population. This study aimed to investigate the relationship between HIV infection, malignant syphilis, and neurosyphilis through a systematic chart review of 26 malignant syphilis patients seen at our hospital. We also performed a literature review of 83 reported malignant syphilis cases since 1987, when the first case of malignant syphilis co-infected with HIV was reported. We found there was no direct association between HIV infection and malignant syphilis or neurosyphilis. In contrast, we found that much higher proportion (30%) of malignant syphilis patients develop concurrent neurosyphilis compared to those with the common type of secondary syphilis (13.1%). Physicians should be aware of the fact that neurosyphilis is more common among patients with malignant syphilis and the importance of investigating for neurosyphilis in such patients.
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Affiliation(s)
- Lin Zhu
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Mei Shi
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Rui-Rui Peng
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Xin Gu
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Zhifang Guan
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Huanbin Xu
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Pingyu Zhou
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
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13
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Fustà-Novell X, Morgado-Carrasco D, Barreiro-Capurro A, Manzardo C, Alsina-Gibert M, Fuertes-de Vega I, Blanco JL, González A, Moreno A, Álvarez M, Bosch J. Syphilis Maligna: A Presentation to Bear in Mind. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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14
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Pradhan S, Sirka CS, Panda M, Baisakh M. Lues Maligna in an Immunocompetent Female. Indian Dermatol Online J 2018; 9:344-346. [PMID: 30258808 PMCID: PMC6137667 DOI: 10.4103/idoj.idoj_277_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Swetalina Pradhan
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Chandra S Sirka
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Maitreyee Panda
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Manas Baisakh
- Department of Pathology, Prolife Diagnostics, Bhubaneswar, Odisha, India
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15
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Fustà-Novell X, Morgado-Carrasco D, Barreiro-Capurro A, Manzardo C, Alsina-Gibert M. Syphilis Maligna: A Presentation to Bear in Mind. ACTAS DERMO-SIFILIOGRAFICAS 2018; 110:232-237. [PMID: 30098705 DOI: 10.1016/j.ad.2018.02.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 01/30/2018] [Accepted: 02/04/2018] [Indexed: 11/26/2022] Open
Abstract
Malignant syphilis is an uncommon form of secondary syphilis associated with HIV infection. Clinically, it is characterized by necrotic nodules and generalized ulcerated lesions. We present 4 cases of malignant syphilis diagnosed after evaluating syphilis cases diagnosed at our hospital between 2012 and 2016. We describe the epidemiologic, clinical, histiopathologic, and serologic characteristics of malignant syphilis and explore its response to treatment and association with HIV infection. Although malignant syphilis is uncommon, there has been an increase in the number of cases published in recent years, particularly in young HIV-positive patients. Malignant syphilis must be contemplated in the differential diagnosis of HIV patients with ulcerated, necrotic lesions.
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Affiliation(s)
- X Fustà-Novell
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - A Barreiro-Capurro
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - C Manzardo
- Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - M Alsina-Gibert
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España.
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- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España; Servicio de Microbiología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
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16
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Delgado S, Caceres J. Malignant Syphilis in a Human Immunodeficient Virus-Infected Patient. Am J Trop Med Hyg 2018; 96:523-524. [PMID: 28471744 PMCID: PMC5361521 DOI: 10.4269/ajtmh.16-0755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Sandra Delgado
- Department of Tropical Medicine and Dermatology, Institute Alexander von Humbolt, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Jaime Caceres
- Department of Pathology, Hospital Cayetano Heredia, Lima, Perú
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17
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An Uncommon Presentation of a Common Infection. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2018. [DOI: 10.1097/ipc.0000000000000620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Barros D'Elia Zanella L, Facchini Lellis R, Khoury Z, Keiko Matsuka Oyafuso L, Figueiredo-Mello C. Rupioid lesions, PLEVA and superposition phenomenon in malignant syphilis: two case reports in HIV-infected patients. J Eur Acad Dermatol Venereol 2017; 32:e91-e92. [DOI: 10.1111/jdv.14563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
| | - R. Facchini Lellis
- Emilio Ribas Infectious Diseases Institute (IIER); São Paulo Brazil
- Medical School of Santa Casa; São Paulo Brazil
| | - Z. Khoury
- Emilio Ribas Infectious Diseases Institute (IIER); São Paulo Brazil
| | - L. Keiko Matsuka Oyafuso
- Emilio Ribas Infectious Diseases Institute (IIER); São Paulo Brazil
- Medical School of ABC; São Paulo Brazil
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19
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Gianfaldoni S, Tchernev G, Wollina U, Gianfaldoni R, Lotti T. Secondary Syphilis Presenting As Palmoplantar Psoriasis. Open Access Maced J Med Sci 2017; 5:445-447. [PMID: 28785328 PMCID: PMC5535653 DOI: 10.3889/oamjms.2017.087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 04/19/2017] [Accepted: 04/20/2017] [Indexed: 11/05/2022] Open
Abstract
In a recent past, the incidence of syphilis has increased in various geographical regions. The authors describe a case of secondary syphilis mimicking palmoplantar psoriasis.
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Affiliation(s)
- Serena Gianfaldoni
- University G. Marconi of Rome, Dermatology and Venereology, Rome 00192, Italy
| | - Georgi Tchernev
- Medical Institute of the Ministry of Interior, Dermatology, Venereology and Dermatologic Surgery; Onkoderma, Private Clinic for Dermatologic Surgery, Dermatology and Surgery, Sofia 1606, Bulgaria
| | - Uwe Wollina
- Krankenhaus Dresden-Friedrichstadt, Department of Dermatology and Venereology, Dresden, Sachsen, Germany
| | - Roberto Gianfaldoni
- University G. Marconi of Rome, Dermatology and Venereology, Rome 00192, Italy
| | - Torello Lotti
- Univerisity G. Marconi of Rome, Dermatology and Venereology, Rome, Italy; Universitario di Ruolo, Dipartimento di Scienze Dermatologiche, Università degli Studi di Firenze, Facoltà di Medicina e Chirurgia, Dermatology, Via Vittoria Colonna 11, Rome 00186, Italy
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20
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Yap FHX, Ricciardo B, Manjri Tiwari S, French MA, Italiano CM, Vinciullo C. A rare case of lues maligna with ocular involvement presenting as an unmasking immune reconstitution inflammatory syndrome in a patient with HIV infection. Australas J Dermatol 2017; 59:148-150. [DOI: 10.1111/ajd.12678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Francis HX Yap
- Department of Dermatology; Royal Perth Hospital; Perth Western Australia Australia
| | - Bernadette Ricciardo
- Department of Dermatology; Fiona Stanley Hospital; Perth Western Australia Australia
| | - Shevya Manjri Tiwari
- Department of Dermatology; Royal Perth Hospital; Perth Western Australia Australia
| | - Martyn A French
- Department of Immunology; Royal Perth Hospital; Perth Western Australia Australia
| | - Claire M Italiano
- Department of Microbiology and Infectious Diseases; Royal Perth Hospital; Perth Western Australia Australia
| | - Carl Vinciullo
- Department of Dermatology; Royal Perth Hospital; Perth Western Australia Australia
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21
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Gevorgyan O, Owen BD, Balavenkataraman A, Weinstein MR. A nodular-ulcerative form of secondary syphilis in AIDS. Proc AMIA Symp 2017; 30:80-82. [PMID: 28127144 PMCID: PMC5242125 DOI: 10.1080/08998280.2017.11929539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
An uncommon variant in the pre-AIDS era, lues maligna is a nodular-ulcerative form of secondary syphilis. We present a case of a 41-year-old man with HIV infection who developed fever, chills, nausea, vomiting, right upper quadrant abdominal pain, weight loss, watery diarrhea, and a painless, nonpruritic rash. He had diffuse nodular-ulcerative lesions in various stages of development. He was found to have a CD4 count of 101 cells/mm3 (22%), an HIV viral load of 2,735,060 copies/mL, and a positive rapid plasma reagin at 1:64. He was started on emtricitabine, tenofovir, and dolutegravir, as well as doxycycline. He was given benzathine penicillin 2.4 million units intramuscularly and within hours developed a Jarisch-Herxheimer reaction. Skin lesions showed signs of healing, and constitutional symptoms improved 48 hours later.
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Affiliation(s)
- Ofelya Gevorgyan
- Department of Medicine, Section of Infectious Diseases, Presence Saint Joseph Hospital, Chicago, Illinois
| | - Benjamin D Owen
- Department of Medicine, Section of Infectious Diseases, Presence Saint Joseph Hospital, Chicago, Illinois
| | - Arvind Balavenkataraman
- Department of Medicine, Section of Infectious Diseases, Presence Saint Joseph Hospital, Chicago, Illinois
| | - Mitchell R Weinstein
- Department of Medicine, Section of Infectious Diseases, Presence Saint Joseph Hospital, Chicago, Illinois
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22
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Ivars Lleó M, Clavo Escribano P, Menéndez Prieto B. Atypical Cutaneous Manifestations in Syphilis. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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23
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Ivars Lleó M, Clavo Escribano P, Menéndez Prieto B. Atypical Cutaneous Manifestations in Syphilis. ACTAS DERMO-SIFILIOGRAFICAS 2015; 107:275-83. [PMID: 26708562 DOI: 10.1016/j.ad.2015.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 10/26/2015] [Accepted: 11/07/2015] [Indexed: 11/16/2022] Open
Abstract
Although the diversity of the clinical manifestations of syphilis is well-known, atypical presentations can also occur. Such atypical presentations are associated with a high risk of transmission as a result of diagnostic confusion and treatment delays owing to the disease's ability to mimic other common skin diseases, deviate from classic clinical presentations, and adopt unique forms. Cases of atypical syphilis have been described most frequently in patients with concomitant human immunodeficiency virus (HIV) infection. Because the incidence of syphilis has been growing over recent years -particularly in patients with HIV co-infection- dermatologists need to be familiar with the less well-known clinical presentations of this venereal disease.
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Affiliation(s)
- M Ivars Lleó
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona, España.
| | - P Clavo Escribano
- Departamento de Dermatología, Centro Sanitario Sandoval, Madrid, España
| | - B Menéndez Prieto
- Departamento de Microbiología, Centro Sanitario Sandoval, Madrid, España
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24
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Yamashita M, Fujii Y, Ozaki K, Urano Y, Iwasa M, Nakamura S, Fujii S, Abe M, Sato Y, Yoshino T. Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma. Diagn Pathol 2015; 10:185. [PMID: 26449225 PMCID: PMC4599588 DOI: 10.1186/s13000-015-0419-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/01/2015] [Indexed: 12/31/2022] Open
Abstract
Malignant syphilis or lues maligna is a severe form of secondary syphilis that was commonly reported in the pre-antibiotic era, and has now reemerged with the advent of the human immunodeficiency virus (HIV) epidemic. However, the characteristic histopathological findings of malignant syphilis remain controversial. The aim of this case report was to clarify the clinical and histopathological findings of HIV-positive malignant secondary syphilis. A Japanese man in his forties complained of fever, skin lesions, headache, and myalgia without lymphadenopathy during the previous 4 weeks. The skin lesions manifested as erythematous, nonhealing, ulcerated papules scattered on his trunk, extremities, palm, and face. Although the skin lesions were suspected to be cutaneous T-cell lymphomas on histological analyses, they lacked T-cell receptor Jγ rearrangement; moreover, immunohistochemical analyses confirmed the presence of spirochetes. The patient was administered antibiotics and anti-retroviral therapy, which dramatically improved the symptoms. On the basis of these observations of the skin lesions, we finally diagnosed the patient with HIV-associated secondary syphilis that mimicked cutaneous T-cell lymphoma. The patient’s systemic CD4+ lymphocyte count was very low, and the infiltrate was almost exclusively composed of CD8+ atypical lymphocytes; therefore, the condition was easily misdiagnosed as cutaneous lymphoma. Although the abundance of plasma cells is a good indicator of malignant syphilis on skin histological analyses, in some cases, the plasma cell count may be very low. Therefore, a diagnosis of malignant secondary syphilis should be considered before making a diagnosis of primary cutaneous peripheral T-cell lymphoma or lymphoma associated with HIV infection.
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Affiliation(s)
- Michiko Yamashita
- Division of Diagnostic Pathology, Tokushima Red Cross Hospital, 103, Irinokuchi, Komatsushima-cho, Komatsushima-shi, Tokushima, 7738502, Japan.
| | - Yoshiyuki Fujii
- Division of Diagnostic Pathology, Tokushima Red Cross Hospital, 103, Irinokuchi, Komatsushima-cho, Komatsushima-shi, Tokushima, 7738502, Japan.
| | - Keiji Ozaki
- Division of Hematology, Tokushima Red Cross Hospital, Tokushima, Japan.
| | - Yoshio Urano
- Division of Dermatology, Tokushima Red Cross Hospital, Tokushima, Japan.
| | - Masami Iwasa
- Division of Hematology, Tokushima University Hospital, Tokushima, Japan.
| | - Shingen Nakamura
- Division of Hematology, Tokushima University Hospital, Tokushima, Japan.
| | - Shiro Fujii
- Division of Hematology, Tokushima University Hospital, Tokushima, Japan.
| | - Masahiro Abe
- Division of Hematology, Tokushima University Hospital, Tokushima, Japan.
| | - Yasuharu Sato
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
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Pathologically confirmed malignant syphilis using immunohistochemical staining: report of 3 cases and review of the literature. Sex Transm Dis 2014; 41:94-7. [PMID: 24413487 DOI: 10.1097/olq.0000000000000084] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Malignant syphilis is a rare ulcerative variety. In the classical description of the disease, the absence of spirochetes in tissue samples was considered as a diagnostic criterion. We report 3 cases of malignant syphilis; in all of them, spirochetes were identified in cutaneous biopsy samples using immunohistochemical staining.
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Alves J, António AM, Matos D, Coelho R, Cachão P. Malignant lues in an immunocompetent patient. Int J STD AIDS 2014; 26:518-20. [PMID: 25015934 DOI: 10.1177/0956462414544162] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 06/23/2014] [Indexed: 11/17/2022]
Abstract
Malignant lues is a rare form of secondary syphilis mostly associated with HIV infection. It is an uncommon presentation of syphilis even rarer in immunocompetent patients. We present the case of a 57-year-old homosexual man referred to our department due to a 4-month history of a disseminated, slightly painful, nodular-ulcerative cutaneous eruption associated with low-grade fever, malaise and aesthenia. Regarding the clinical features and serological and histopathological findings, the diagnosis of syphilis maligna was assumed. Serology for HIV was repeatedly negative. This case is interesting, not only because a very uncommon form of secondary syphilis was identified but also for being diagnosed in an immunocompetent patient. Lack of awareness of this type of presentation delays the diagnosis and treatment, leading to an increase in morbidity and spread of infection.
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Affiliation(s)
- João Alves
- Department of Dermatology and Venereology, Garcia de Orta Hospital, Almada, Portugal
| | - Ana Marta António
- Department of Dermatology and Venereology, Garcia de Orta Hospital, Almada, Portugal
| | - Diogo Matos
- Department of Dermatology and Venereology, Garcia de Orta Hospital, Almada, Portugal
| | - Ricardo Coelho
- Department of Dermatology and Venereology, Garcia de Orta Hospital, Almada, Portugal
| | - Pedro Cachão
- Department of Dermatology and Venereology, Garcia de Orta Hospital, Almada, Portugal
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27
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Abstract
Lues maligna is a severe and rare manifestation of syphilis, also known as malignant syphilis or ulceronodular syphilis and mostly occurring in patients with HIV infection. In this report, we present a case of lues maligna in an AIDS patient. Our report shows the typical clinical features of lues maligna and the important association between lues maligna and HIV/AIDS. Although the clinical manifestations of lues maligna are complicated and severe, the response to the therapy of penicillin is excellent.
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Affiliation(s)
- H Wang
- Department of Dermatology and Venereology, First Hospital of Jilin University
| | - X Wang
- Department of Infectious Diseases, Changchun City Hospital for Infectious Diseases, Changchun, Jilin, China
| | - S Li
- Department of Dermatology and Venereology, First Hospital of Jilin University
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Yanagisawa N, Ando M, Imamura A, Akagi K, Horiguchi SI, Suganuma A, Ajisawa A. Pathologically confirmed malignant syphilis in an HIV-infected patient. Intern Med 2011; 50:2423-6. [PMID: 22001480 DOI: 10.2169/internalmedicine.50.5605] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of pathologically confirmed malignant syphilis in an HIV-infected patient. Physical examinations revealed ulceronecrotic skin lesions. Skin biopsies demonstrated syphilis spirochetes on immunohistochemical stain, and syphilis serological titers were positive. Treatment with intravenous penicillin G was begun, and complete resolution of the skin lesions was observed. A rapid plasma reagin titer test performed 3 months after treatment revealed a 4-fold reduction in the titer, indicating successful treatment.
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Affiliation(s)
- Naoki Yanagisawa
- Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, Japan.
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29
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Abstract
BACKGROUND Lues maligna (also known as malignant syphilis or ulceronodular syphilis) is a rare dermatologic manifestation of syphilis more commonly seen in patients with HIV infection. The classic lesion of lues maligna is an oval, papulopustular skin lesion with well demarcated borders sometimes covered with a lamellar crust, but myriad clinical presentations of this disease also exist. GOALS To report a presentation of lues maligna in a patient with probable early HIV infection, emphasizing the diagnostic criteria and clinical manifestations of lues maligna. STUDY DESIGN Case report of lues maligna in a patient with probable early HIV infection. CONCLUSIONS As syphilis becomes more common in many developed regions, it is important to recognize even atypical presentations of this clinical entity, especially among individuals who have unrecognized or early HIV infection.
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Pleimes M, Hartschuh W, Kutzner H, Enk A, Hartmann M. Malignant Syphilis with Ocular Involvement and Organism‐Depleted Lesions. Clin Infect Dis 2009; 48:83-5. [DOI: 10.1086/594127] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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31
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Yanagisawa N, Imamura A. HIV‐Positive Man with Ulceronecrotic Skin Lesions. Clin Infect Dis 2008. [DOI: 10.1086/592070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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32
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Abstract
The past decade has shown a significant rise in the prevalence of infective syphilis in the developed world, and striking increases in its frequency have occurred in Eastern Europe, particularly the UK, and in the US. Although oral manifestations of syphilis are most likely to be observed during secondary disease, all stages of the disease can give rise to oral lesions. Significant oral lesions such as gumma-associated bony destruction and a possible predisposition to oral squamous cell carcinoma are associated with tertiary disease. Since the prevalence of infective syphilis in heterosexuals has been increasing, there has now been a gradual rise in the number of children born with congenital syphilis. Consequently, the congenital disease gives rise to dental anomalies as well as bone, skin, and neurological anomalies of the face. The aim of this report is to review syphilis-related oral lesions, as well as to summarize the relations between human immunodeficiency virus (HIV) and syphilis.
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Affiliation(s)
- Jair Carneiro Leão
- Department of Clinic and Preventive Dentistry, Federal University of Pernambuco, Recife/PE, Brazil.
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33
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Abstract
Syphilis is a sexually transmitted disease with protean manifestations resulting from infection by Treponema pallidum. It is systemic early from the outset, the primary pathology being vasculitis. Acquired syphilis can be divided into primary, secondary, latent, and tertiary stages. The infection can also be transmitted vertically resulting in congenital syphilis, and occasionally by blood transfusion and non-sexual contact. Diagnosis is mainly by dark field microscopy in early syphilis and by serological tests. The management in the tropics depends on the diagnostic facilities available: in resource poor countries, primary syphilis is managed syndromically as for anogenital ulcer. The introduction of rapid "desktop" serological tests may simplify and promote widespread screening for syphilis. The mainstay of treatment is with long acting penicillin. Syphilis promotes the transmission of HIV and both infections can simulate and interact with each other. Treponemes may persist despite effective treatment and may have a role in reactivation in immunosuppressed patients. Partner notification, health education, and screening in high risk populations and pregnant women to prevent congenital syphilis are essential aspects in controlling the infection.
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Affiliation(s)
- B T Goh
- The Ambrose King Centre, The Royal London Hospital, Whitechapel, London E1 1BB, UK.
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34
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Scott CM, Flint SR. Oral syphilis—re-emergence of an old disease with oral manifestations. Int J Oral Maxillofac Surg 2005; 34:58-63. [PMID: 15617968 DOI: 10.1016/j.ijom.2004.01.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2004] [Indexed: 10/26/2022]
Abstract
Three representative cases of oral primary syphilis are presented. We wish to highlight the resurgence of this disease, which has occurred recently in the western world, particularly in Europe and the United States of America. Since the initial presentation may be oral, it is important to include syphilis in the differential diagnosis of patients presenting to oral diagnostic clinics with atypical oral ulceration. Recent developments in the serological diagnostic tests and treatment are reviewed. Early diagnosis and treatment has significant implications, not only for the patient, but also for previous and future transmission to contacts. Early syphilis is a highly infectious disease in which the lesions heal spontaneously, despite inappropriate treatment which may appear curative, and yet the patient remains infectious. It is therefore important that clinicians maintain a high clinical index of suspicion and crucial that an accurate diagnosis be made at presentation.
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Affiliation(s)
- C M Scott
- Department of Oral Surgery, Oral Medicine and Oral Pathology, School of Dental Science, Trinity College, Dublin 2, Ireland
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35
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Abstract
An important theme that emerges from all early historical accounts is that in addition to the decreased virulence of Treponema pallidum, the incidence of secondary syphilis has decreased drastically over the past three centuries. Even in the early 20th century, most syphilologists were of the opinion that the disease had undergone changes in its manifestations and that they were dealing with an attenuated form of the spirochete. Such opinions were based primarily on the observations that violent cutaneous reactions and fatalities associated with the secondary stage had become extremely rare. The rate of primary and secondary syphilis in the United States increased in 2002 for the second consecutive year. After a decade-long decline that led to an all-time low in 2000, the recent trend is attributable, to a large extent, by a increase in reported syphilis cases among men, particularly homosexual and bisexual men having sex with men. The present review addresses the clinical and diagnostic criteria for the recognition of secondary syphilis, the clinical course and manifestations of the disease if allowed to proceed past the primary stage of disease in untreated individuals, and the treatment for this stage of the disease.
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Affiliation(s)
- Robert E Baughn
- Baylor College of Medicine, Syphilis Research Laboratory, Bldg. 109, Room 234A, VA Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, USA.
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Körber A, Dissemond J, Hillen U, Goos M, Esser S. [HIV-positive patient with multiple ulcers. Lues maligna]. Hautarzt 2004; 54:1098-102. [PMID: 14593469 DOI: 10.1007/s00105-003-0619-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Körber
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Essen
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37
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Abstract
Syphilis is a sexually transmitted infection which is systemic from the outset and has increased in incidence worldwide over the last decade. There has been concern as to whether or not co-infection with HIV can modify the clinical presentation of syphilis and, as a genital ulcer disease, it can facilitate the transmission of HIV infection. Diagnosis is based on the microscopic identification of the causative treponeme and serological testing. Recommendations for the treatment of syphilis have been based on expert opinion, case series, some clinical trials and 50 years of clinical experience. Penicillin, given intramuscularly, is the mainstay of treatment and the favoured preparations for early infectious syphilis are benzathine penicillin as a single injection or a course of daily procaine penicillin injections for 10 to 14 days. The duration of treatment is longer for late syphilis. There has been concern that benzathine penicillin may not prevent the development of neurosyphilis but that is a rare outcome with this therapy. The main alternative to penicillin is doxycycline, but the place of azithromycin and ceftriaxone is yet to be established. It is not necessary to carry out examination of the cerebrospinal fluid in patients with early infectious syphilis but it should be performed in those with neurological or ocular signs, psychiatric signs or symptoms, when there is evidence of treatment failure and in those who are co-infected with HIV. Follow-up is an essential part of management and should be particularly assiduous, for at least 24 months, in those co-infected with HIV. Partner notification should be mandatory to try to contain the spread of infection.
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Affiliation(s)
- David Pao
- Department of Genitourinary Medicine, Guy's & St Thomas' Hospitals, Lambeth Palace Road, London SE1 7EH, UK
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38
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Kumar B, Gupta S, Muralidhar S. Mucocutaneous manifestations of secondary syphilis in north Indian patients: a changing scenario? J Dermatol 2001; 28:137-44. [PMID: 11349464 DOI: 10.1111/j.1346-8138.2001.tb00107.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
During the 1990s, no studies of various clinical presentations of syphilis have been published in the indexed literature. However, a change in the clinical profile of secondary syphilis was expected during the last decade with the rapid spread of the HIV epidemic. The objective was to study the mucocutaneous manifestations of secondary syphilis in patients attending the STD clinic at the Postgraduate Institute of Medical Education & Research Chandigarh, India, during the last decade and to compare them with other similar studies published during the 1980s. All patients who were diagnosed with secondary syphilis in our STD clinic from 1990 to 1999 were examined and investigated. Serological response was measured at 3, 6, 9, 12, and 24 months post-treatment or until serological negativity was reached. Fifty-three patients (males = 34, female = 19) during this period were found to have secondary syphilis. The most common symptoms were as follows-skin rash 38 (71.7%), lymphadenopathy 26 (49%), persistent chancre 4 (7.5%), nodular syphilides 2 (3.8%), lues maligna 2 (3.8%), patches in the oral mucosa 6 (11.3%), condylomata lata 14 (26.4%), split papules 2 (3.8%). Five patients had a thin and conspicuous genital scar of the healed primary chancre. Three patients were HIV seropositive (1 patient each with lues maligna, lichenoid, and nodular syphilides). With the spread of the HIV epidemic, atypical muco-cutaneous manifestations of secondary syphilis may be seen more frequently than before and may pose problems in diagnosis. In the present study, six patients had atypical manifestations, and three of them were HIV seropositive.
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Affiliation(s)
- B Kumar
- Department of Dermatology Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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