Rupioid lesions, PLEVA and superposition phenomenon in malignant syphilis: two case reports in HIV-infected patients

Malignant syphilis in a young woman: A case report

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.

Malignant Syphilis: A Systematic Review of the Case Reports Published in 2014-2018

Malignant syphilis (MS) is a rare manifestation of secondary syphilis which mainly occurs in immunocompromised individuals such as those coinfected with human immunodeficiency virus (HIV). However, recent reports have described MS in immunocompetent individuals. To describe the characteristics of individuals with MS and associated risk factors, a review of case reports published from 2014 to 2018 was conducted. Out of 45 published case reports, 33 cases (73%) occurred in HIV-positive individuals with majority having CD4 counts < 500 cells/mm3. Of the 12 cases (27%) in HIV-negative individuals, half had comorbidities such as diabetes mellitus, alcoholism, drug abuse, psoriasis, and hepatitis. The most frequent manifestation of MS was ulceronodular cutaneous lesions with central adherent crust, which affected the face, trunk, and limbs. Given the increasing number of MS regardless of the immune status, dermatologists and general practitioners should be vigilant to allow early diagnosis and treatment, hence reducing their morbidity.

Neurosyphilis is more common in malignant syphilis: A case series and review of the literature

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.