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Montenegro-Idrogo JJ, Muñante R, López-Fuentes M, Sanz-Castro M, Ventura-León A, Chávez-Esparza G, García-Cortez Y. Malignant syphilis as the presenting complaint of advanced HIV. Int J STD AIDS 2023:9564624231162415. [PMID: 36920282 DOI: 10.1177/09564624231162415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Malignant syphilis is an infrequent secondary manifestation in patients with human immunodeficiency virus (HIV), with polymorphous and disseminated skin lesions being related to severe immunosuppression. Lesions have intense inflammatory circinate, ulcer-crusted and nodular skin lesions of diffuse distribution throughout the body, that can be confused with vasculitis or cutaneous lymphomas. We report a patient recently diagnosed with HIV infection in the acquired immunodeficiency syndrome stage with malignant syphilis as the debut of HIV.
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Affiliation(s)
- Juan José Montenegro-Idrogo
- 471931Facultad de Ciencias de La Salud Universidad Científica Del Sur, Lima, Perú.,Servicio de Medicina de Enfermedades Infecciosas y Tropicales, 504674Hospital Nacional Dos de Mayo, Lima, Perú
| | - Ricardo Muñante
- Servicio de Medicina de Enfermedades Infecciosas y Tropicales, 504674Hospital Nacional Dos de Mayo, Lima, Perú
| | - Manuel López-Fuentes
- Servicio de Anatomía Patológica, 504674Hospital Nacional Dos de Mayo, Lima, Perú
| | | | | | - Gonzalo Chávez-Esparza
- Servicio de Medicina de Enfermedades Infecciosas y Tropicales, 504674Hospital Nacional Dos de Mayo, Lima, Perú
| | - Yuri García-Cortez
- Servicio de Medicina de Enfermedades Infecciosas y Tropicales, 504674Hospital Nacional Dos de Mayo, Lima, Perú
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2
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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)
| | | | - Xiao-Yong Man
- Xiao-Yong Man, Department of Dermatology,
Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang
Road, Hangzhou, 310009, Zhejiang Province, China.
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3
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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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Wibisono O, Idrus I, Djawad K. Malignant Syphilis: A Systematic Review of the Case Reports Published in 2014-2018. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S1578-2190(21)00174-8. [PMID: 34052138 DOI: 10.1016/j.adengl.2021.05.014] [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: 10/05/2020] [Accepted: 02/13/2021] [Indexed: 01/06/2023] Open
Abstract
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.
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Affiliation(s)
- O Wibisono
- Servicio de Dermatología y Venereología, Facultad de Medicina de la Universidad de Hasanuddin, Makassar, Indonesia; Hospital Dr. Wahidin Sudirohusodo, Makassar, Indonesia.
| | - I Idrus
- Servicio de Dermatología y Venereología, Facultad de Medicina de la Universidad de Hasanuddin, Makassar, Indonesia
| | - K Djawad
- Servicio de Dermatología y Venereología, Facultad de Medicina de la Universidad de Hasanuddin, Makassar, Indonesia; Hospital Dr. Wahidin Sudirohusodo, Makassar, Indonesia
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5
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Wibisono O, Idrus I, Djawad K. Malignant Syphilis: A Systematic Review of the Case Reports Published in 2014-2018. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00135-6. [PMID: 33811833 DOI: 10.1016/j.ad.2021.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/26/2021] [Accepted: 02/13/2021] [Indexed: 01/01/2023] Open
Abstract
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.
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Affiliation(s)
- O Wibisono
- Servicio de Dermatología y Venereología, Facultad de Medicina de la Universidad de Hasanuddin, Makassar, Indonesia; Hospital Dr. Wahidin Sudirohusodo, Makassar, Indonesia.
| | - I Idrus
- Servicio de Dermatología y Venereología, Facultad de Medicina de la Universidad de Hasanuddin, Makassar, Indonesia
| | - K Djawad
- Servicio de Dermatología y Venereología, Facultad de Medicina de la Universidad de Hasanuddin, Makassar, Indonesia; Hospital Dr. Wahidin Sudirohusodo, Makassar, Indonesia
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Unusual Histopathological Features in a Case of Seronegative Lues Maligna. Am J Dermatopathol 2020; 43:396-397. [PMID: 33156023 DOI: 10.1097/dad.0000000000001835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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7
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Forrestel AK, Kovarik CL, Katz KA. Sexually acquired syphilis: Historical aspects, microbiology, epidemiology, and clinical manifestations. J Am Acad Dermatol 2019; 82:1-14. [PMID: 30986477 DOI: 10.1016/j.jaad.2019.02.073] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/10/2019] [Accepted: 02/12/2019] [Indexed: 01/03/2023]
Abstract
Syphilis is caused by infection with the spirochetal bacterium Treponema pallidum subsp. pallidum. It was first recognized in the late 15th century. Since 2000, the incidence of sexually acquired syphilis has increased substantially in the developed world, with men who have sex with men and persons living with HIV infection disproportionately affected. Clinical manifestations of syphilis are protean and often include mucocutaneous manifestations. The first article in this continuing medical education series reviews historical aspects, microbiology, epidemiology, and clinical manifestations of sexually acquired syphilis.
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Affiliation(s)
- Amy K Forrestel
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth A Katz
- Department of Dermatology, Kaiser Permanente, San Francisco, California
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Li X, Xia J, Padma M, Ma Z, Tian Y. Cutaneous leukocytoclastic vasculitis as the first manifestation of malignant syphilis coinfected with human immunodeficiency virus. J Cutan Pathol 2019; 46:393-395. [PMID: 30632201 DOI: 10.1111/cup.13420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/22/2018] [Accepted: 12/05/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Xiao Li
- Department of Dermatology and Venerology, First Hospital of Jilin University, Changchun, Jilin, China
| | - Jianxin Xia
- Department of Dermatology and Venerology, Second Hospital of Jilin University, Changchun, Jilin, China
| | - Malla Padma
- Department of Dermatology and Venerology, First Hospital of Jilin University, Changchun, Jilin, China
| | - Zhenghui Ma
- Department of Dermatology and Venerology, First Hospital of Jilin University, Changchun, Jilin, China
| | - Yaping Tian
- Department of Dermatology and Venerology, First Hospital of Jilin University, Changchun, Jilin, China
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9
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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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10
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Mena Lora AJ, Braniecki M, Nasir A, Brito M. The great impostor: Lues maligna in an HIV-infected male. SAGE Open Med Case Rep 2017; 5:2050313X17731050. [PMID: 28955441 PMCID: PMC5607913 DOI: 10.1177/2050313x17731050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 08/16/2017] [Indexed: 11/15/2022] Open
Abstract
Lues maligna is a rare severe cutaneous manifestation of secondary syphilis. It is also known as malignant syphilis and ulceronodular syphilis. We report a case of a 58-year-old HIV-infected male who presented with diffuse, pruritic, non-tender, maculo-papular skin lesions, ulcerated nodules and plaques surrounded by an erythematous base. The disseminated skin lesions were at various stages and were located on his back, chest, arms and testicles. Patient had been receiving antiretroviral therapy. Laboratory studies had demonstrated CD4 lymphocyte count of 463 cells/mm3 and an undetectable HIV viral load. Workup revealed a rapid plasma reagin of 1:256 dilutions and the skin biopsy findings were compatible with syphilis. The skin lesions resolved with intramuscular penicillin. We herein describe a rare case of lues maligna in an HIV-infected patient with a preserved immune function and viral suppression. Such skin lesions can mimic fungal or mycobacterial infections and can pose a diagnostic challenge. Even in the modern era, syphilis remains the great impostor. Clinicians must be able to recognize this condition based on clinical characteristics and risk factors to diagnose and treat this condition promptly.
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Affiliation(s)
| | | | - Ayman Nasir
- Ross University School of Medicine, Miramar, FL, USA
| | - Maximo Brito
- The University of Illinois at Chicago, Chicago, IL, USA
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11
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Cabrera-Fuentes R, Ortiz-Prieto A, Zulueta-Dorado T, Conejo-Mir J. Fever and ulcerative-necrotic lesions in a 38 years old male. Enferm Infecc Microbiol Clin 2017; 36:386-387. [PMID: 28438351 DOI: 10.1016/j.eimc.2017.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Raquel Cabrera-Fuentes
- Servicio de Dermatología y Venereología, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - Alejandro Ortiz-Prieto
- Servicio de Dermatología y Venereología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Teresa Zulueta-Dorado
- Servicio de Anatomía Patológica, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Julián Conejo-Mir
- Servicio de Dermatología y Venereología, Hospital Universitario Virgen del Rocío, Sevilla, España
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12
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Sammet S, Draenert R. Case report of three consecutive lues maligna infections in an HIV-infected patient. Int J STD AIDS 2016; 28:523-525. [PMID: 28266263 DOI: 10.1177/0956462416674102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lues maligna is a rare presentation of an infection with Treponema pallidum. Here we report three lues maligna infections with severe dermatological manifestations in a single HIV-1 infected individual. Despite the start of highly active antiretroviral therapy and a substantial increase in CD4 cell count after the first episode, he developed consecutive episodes. We assume a specific immunological predisposition to react to T. pallidum in this patient.
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Affiliation(s)
- Stefanie Sammet
- Medizinische Klinik und Poliklinik IV, Section Infectious Diseases, Klinikum der Universität München, Munich, Germany
| | - Rika Draenert
- Medizinische Klinik und Poliklinik IV, Section Infectious Diseases, Klinikum der Universität München, Munich, Germany
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