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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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2
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Affiliation(s)
- Jia-Wei Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Skin and Immune Diseases, Beijing, P.R. China
| | - Dong-Lai Ma
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Skin and Immune Diseases, Beijing, P.R. China.
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3
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Alexanian C, Le S, Ma C, Fung M, Tartar D. Umbilical condyloma lata. Dermatol Online J 2019; 25:13030/qt2zf38865. [PMID: 30865413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 06/09/2023] Open
Abstract
Condyloma lata, a cutaneous manifestation of secondary syphilis, usually appear as verrucous papules and plaques in the anogenital area. Involvement of the umbilicus is very uncommon. Thus, awareness of this presentation, along with appropriate history, physical exam, and laboratory testing may aid clinicians in prompt and accurate diagnosis. We describe a patient with an unusual presentation of condyloma lata on the umbilicus.
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Affiliation(s)
| | | | | | | | - Danielle Tartar
- Department of Dermatology, University of California, Davis Medical Center, Sacramento, California.
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4
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Affiliation(s)
- Antonio Faraone
- Department of Internal Medicine, "San Giovanni di Dio" Hospital, Via di Torregalli 3, 50143 Florence, Italy.
| | - Alberto Fortini
- Department of Internal Medicine, "San Giovanni di Dio" Hospital, Via di Torregalli 3, 50143 Florence, Italy
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5
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Bartels A, Crandall M, Spring L. Recalcitrant genital papules. J Fam Pract 2017; 66:457-460. [PMID: 28700763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This patient was initially told he had genital warts, but the appearance of the lesions, and the presence of a rash on his trunk and extremities, suggested another diagnosis.
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Affiliation(s)
- Anne Bartels
- Department of General Medicine, Naval Hospital Camp Lejeune, NC, USA. E-mail:
| | | | - Leah Spring
- Department of Dermatology, Naval Hospital Camp Lejeune, NC, USA
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Mohan GC, Ali RA, Isache CL, Sharma RK, Perniciaro C. Malignant syphilis: ostraceous, ulceronecrotic lesions in a patient with human immunodeficiency virus. Dermatol Online J 2017; 23:13030/qt3ps899bh. [PMID: 28329469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 06/06/2023] Open
Abstract
We present a 36-year-old HIV-positive man with a sixweek history of spreading, ulcerative, and necroticcutaneous lesions. Laboratory and histopathologicexamination revealed syphilis. This case of malignantsyphilis, also known as lues maligna, is an uncommonvariant of this sexually transmitted infection. This casehighlights the importance of including malignantsyphilis in the differential diagnosis of patientspresenting with a disseminated ulcerative andnecrotic rash, especially in individuals with HIV.
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Affiliation(s)
- Girish C Mohan
- Department of Pathology, University of Florida, UF Health Jacksonville
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7
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Wong CY, Piliang M. Thick scaly plaques on the wrists, knees, and feet. Cutis 2016; 98:147-153. [PMID: 27814410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Militz H, Hungerer C. IMAGES IN CLINICAL MEDICINE. Treponema pallidum--The Great Imitator. N Engl J Med 2015; 373:2069. [PMID: 26580999 DOI: 10.1056/nejmicm1501265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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10
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Flamm A, Parikh K, Xie Q, Kwon EJ, Elston DM. Histologic features of secondary syphilis: A multicenter retrospective review. J Am Acad Dermatol 2015; 73:1025-30. [PMID: 26464219 DOI: 10.1016/j.jaad.2015.08.062] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 08/15/2015] [Accepted: 08/27/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Secondary syphilis has a wide spectrum of clinical and histologic manifestations. OBJECTIVE We sought to determine the frequency of histopathological features characterizing secondary syphilis, and which are most common in specimens displaying few diagnostic findings. METHODS In a multicenter, retrospective analysis of biopsy-proven secondary syphilis, cases were subcategorized by the number of histologic characteristics present. RESULTS The 106 cases mostly had 5 to 7 of the features studied. Many features were scarcer in cases with 5 or fewer features, including endothelial swelling (87.7% overall vs 72.4% ≤5 features), plasma cells (69.8% vs 48.3%), and elongated rete ridges (75.5% vs 27.6%). Specimens with 5 or fewer features were more likely to be truncal (61.1% vs 34.4% overall), demonstrate rete ridge effacement (44.8% vs 19.8%), and have pityriasis rosea (33.3% vs 17.2%) or drug eruption (33.3% vs 10.9%) in the clinical differential. An interstitial inflammatory pattern was the most common characteristic of specimens with 5 or fewer features (75.9%). LIMITATIONS This was a retrospective review. CONCLUSION The independent value of many histologic features of syphilis may be overestimated. Combinations of endothelial swelling, interstitial inflammation, irregular acanthosis, and elongated rete ridges should raise the possibility of syphilis, along with the presence of vacuolar interface dermatitis with a lymphocyte in nearly every vacuole and lymphocytes with visible cytoplasm.
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Affiliation(s)
- Alexandra Flamm
- State University of New York Downstate Medical Center, Brooklyn, New York.
| | - Kruti Parikh
- Ackerman Academy of Dermatopathology, New York, New York
| | - Qiang Xie
- State University of New York Downstate Medical Center, Brooklyn, New York; Kings County Hospital Center, Brooklyn, New York
| | - Eun Ji Kwon
- Dermpath Diagnostics New York, Port Chester, New York
| | - Dirk M Elston
- State University of New York Downstate Medical Center, Brooklyn, New York; Ackerman Academy of Dermatopathology, New York, New York; Medical University of South Carolina, Charleston, South Carolina
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11
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Affiliation(s)
- Jiu-Hong Li
- Department of Dermatology, No 1 Hospital of China Medical University, Shenyang, China.
| | - Hao Guo
- Department of Dermatology, No 1 Hospital of China Medical University, Shenyang, China
| | - Xing-Hua Gao
- Department of Dermatology, No 1 Hospital of China Medical University, Shenyang, China
| | - Hong-Duo Chen
- Department of Dermatology, No 1 Hospital of China Medical University, Shenyang, China
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12
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Chacon AH. Don't forget about syphilis. Cutis 2015; 96:E31-E33. [PMID: 26367762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Syphilis has extremely variable manifestations that produce an extremely broad differential diagnosis. Care must be taken to consider syphilis in dermatologic and other systemic disorders as is relevant.
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Affiliation(s)
- Anna H Chacon
- 419 W Redwood St, Ste 240, Baltimore, MD 21201, USA.
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Li JH, Guo H, Zheng S, Li B, Gao XH, Chen HD. Widespread Crusted Skin Ulcerations in a Man with Type II Diabetes: A Quiz. Diagnosis: Malignant syphilis. Acta Derm Venereol 2015; 95:632-3. [PMID: 25365992 DOI: 10.2340/00015555-1999] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Jiu-Hong Li
- Department of Dermatology, No.1 Hospital of China Medical University, 155N. Nanjing Street, Shenyang 110001, China.
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Vartolomei MD, Cotoi OS, Badea MA, Chibelean CB, Cotoi T, Morariu V, Albu C, Morariu SH. Indurative Edema of the Prepuce Mimicing Phimosis, an Atypical Manifestation of Primary Syphilis. Acta Dermatovenerol Croat 2015; 23:301-303. [PMID: 26724885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - Ovidiu Simion Cotoi
- Department of Pathophysiology, University of Medicine and Pharmacy, Târgu Mureş, Romania
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15
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Affiliation(s)
- Dong-Lai Ma
- Peking Union Medical College Hospital, Beijing, China
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16
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Ali L, Helm T, Brouha B, Gladsjo J, Cockerell C. Rapidly enlarging noduloulcerative lesions. Lues maligna. Cutis 2014; 94:E20-E22. [PMID: 25279486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Liaqat Ali
- 1314 N Macomb St, Monroe, MI 48162, USA.
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Abstract
Lues maligna, which is characterized by noduloulcerative lesions, is a rare form of secondary syphilis. It is mainly seen in either HIV-infected or malnourished patients suffering from a depression in immunity. We presented a chronic alcoholic, HIV negative male patient with noduloulcerative lesions diagnosed as lues maligna based on his skin eruptions, results of serologic tests, and, histopathologic findings. We believe that chronic alcoholism could be the cause of immunosuppression in our case and wanted to emphasize the possibility of an association between lues maligna and chronic alcoholism.
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Affiliation(s)
- Dilek Bayramgürler
- Kocaeli University Medical Faculty, Dermatology Department, Kocaeli, Turkey
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18
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Huotari-Orava R. [Skin biopsy as a clue - case report]. Duodecim 2013; 129:1103-1106. [PMID: 23767141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Skin biopsy is one of the most important diagnostic tools in dermatologic disorders. It is, however, necessary to combine histological findings with the clinical picture, and diagnosis will not necessarily be reached even from a technically successful biopsy without proper referral data. We describe a case in which biopsies taken from the skin rash of a febrile middle-aged man led to the correct tracks and the syphilis diagnosis was reached in collaboration with the clinician.
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Affiliation(s)
- Riitta Huotari-Orava
- LL, Iho- ja sukupuolitautiern erikoislääkäri, Patologian erikoislääkāri, kliininen opettaja
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19
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Affiliation(s)
- Teresa Jaeger
- Klinik und Poliklinik für Dermatologie und Allergologie der Technischen Universität München, Biedersteiner Str. 29, D-80802 München
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20
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CEDEF. [Item 95--Sexually transmitted diseases: primary and secondary syphilis]. Ann Dermatol Venereol 2012; 139:A62-8. [PMID: 23176864 DOI: 10.1016/j.annder.2012.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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21
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García P, Grassi B, Fich F, Salvo A, Araya L, Abarzúa F, Soto J, Poggi H, Lagos M, Vásquez P, León EP, Pérez C, Wozniak A. [Laboratory diagnosis of Treponema pallidum infection in patients with early syphilis and neurosyphilis through a PCR-based test]. Rev Chilena Infectol 2011; 28:310-315. [PMID: 22052394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Syphilis is a sexually transmitted disease caused by Treponema pallidum. The diagnosis is based mainly in clinical presentation and non-specific assays. PCR-based diagnosis has been suggested as an attractive alternative method. The aim of this study was the validation of a PCR-based test for the diagnosis of early syphilis (ES) and neurosyphilis (NS). Clinical samples of mucocutaneous lesions and cerebrospinal fluid (CSF) specimens from patients previously diagnosed for ES and NS respectively using an enlarged gold standard, were tested by PCR. The reaction was done using primers targeting the tpN47 gene. Twenty out of 21 mucocutaneous samples from patients diagnosed with ES were positive by PCR, with a clinical sensitivity of 95%. Four out of 8 CSF samples from patients previously diagnosed with NS were positive by PCR, with a clinical sensitivity of 50%. The clinical specificity for both ES and NS was 100%. The PCR sensitivity and specificity for mucocutaneous samples allowed us to implement this assay in our laboratory for routine diagnosis. Although the sensitivity of the PCR in CSF was low, it may be useful to support clinical diagnosis.
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Affiliation(s)
- Patricia García
- Departamento de Laboratorios Clínicos,Pontificia Universidad Católica de Chile
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Affiliation(s)
- Yong Hyun Jang
- Department of Dermatology, Ajou University School of Medicine, Yeongtong-Gu, Suwon-si, Kyeonggi-do, South Korea
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Breznik V, Potočnik M, Miljković J. Papulonodular secondary syphilis in a 52-year-old non-HIV heterosexual patient. Acta Dermatovenerol Alp Pannonica Adriat 2010; 19:27-30. [PMID: 21390478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
There has been a recent increase in the incidence of syphilis in Slovenia, similar to other countries. Secondary syphilis can manifest with various clinical and histopathological presentations. We report the case of a 52-year-old patient that presented with nonpruritic nodular lesions on the face, trunk, and insteps that clinically mimicked lymphoma or sarcoidosis. Histopathological findings showed granulomatous inflammation. The serology revealed positive non-treponemal and treponemal tests. Treatment with benzathine penicillin G was successful.
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Affiliation(s)
- V Breznik
- Department of Dermatology, Maribor University Clinical Center, Maribor, Sloveniam
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Pless ML, Kroshinsky D, LaRocque RC, Buchbinder BR, Duncan LM. Case records of the Massachusetts General Hospital. Case 26-2010. A 54-year-old man with loss of vision and a rash. N Engl J Med 2010; 363:865-74. [PMID: 20818848 DOI: 10.1056/nejmcpc1000968] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Misha L Pless
- Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston, USA
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26
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Cruz AR, Pillay A, Zuluaga AV, Ramirez LG, Duque JE, Aristizabal GE, Fiel-Gan MD, Jaramillo R, Trujillo R, Valencia C, Jagodzinski L, Cox DL, Radolf JD, Salazar JC. Secondary syphilis in cali, Colombia: new concepts in disease pathogenesis. PLoS Negl Trop Dis 2010; 4:e690. [PMID: 20502522 PMCID: PMC2872645 DOI: 10.1371/journal.pntd.0000690] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 03/29/2010] [Indexed: 11/18/2022] Open
Abstract
Venereal syphilis is a multi-stage, sexually transmitted disease caused by the spirochetal bacterium Treponema pallidum (Tp). Herein we describe a cohort of 57 patients (age 18-68 years) with secondary syphilis (SS) identified through a network of public sector primary health care providers in Cali, Colombia. To be eligible for participation, study subjects were required to have cutaneous lesions consistent with SS, a reactive Rapid Plasma Reagin test (RPR-titer > or = 1 : 4), and a confirmatory treponemal test (Fluorescent Treponemal Antibody Absorption test- FTA-ABS). Most subjects enrolled were women (64.9%), predominantly Afro-Colombian (38.6%) or mestizo (56.1%), and all were of low socio-economic status. Three (5.3%) subjects were newly diagnosed with HIV infection at study entry. The duration of signs and symptoms in most patients (53.6%) was less than 30 days; however, some patients reported being symptomatic for several months (range 5-240 days). The typical palmar and plantar exanthem of SS was the most common dermal manifestation (63%), followed by diffuse hypo- or hyperpigmented macules and papules on the trunk, abdomen and extremities. Three patients had patchy alopecia. Whole blood (WB) samples and punch biopsy material from a subset of SS patients were assayed for the presence of Tp DNA polymerase I gene (polA) target by real-time qualitative and quantitative PCR methods. Twelve (46%) of the 26 WB samples studied had quantifiable Tp DNA (ranging between 194.9 and 1954.2 Tp polA copies/ml blood) and seven (64%) were positive when WB DNA was extracted within 24 hours of collection. Tp DNA was also present in 8/12 (66%) skin biopsies available for testing. Strain typing analysis was attempted in all skin and WB samples with detectable Tp DNA. Using arp repeat size analysis and tpr RFLP patterns four different strain types were identified (14d, 16d, 13d and 22a). None of the WB samples had sufficient DNA for typing. The clinical and microbiologic observations presented herein, together with recent Cali syphilis seroprevalence data, provide additional evidence that venereal syphilis is highly endemic in this region of Colombia, thus underscoring the need for health care providers in the region to be acutely aware of the clinical manifestations of SS. This study also provides, for the first time, quantitative evidence that a significant proportion of untreated SS patients have substantial numbers of circulating spirochetes. How Tp is able to persist in the blood and skin of SS patients, despite the known presence of circulating treponemal opsonizing antibodies and the robust pro-inflammatory cellular immune responses characteristic of this stage of the disease, is not fully understood and requires further study.
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Affiliation(s)
- Adriana R. Cruz
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | - Allan Pillay
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ana V. Zuluaga
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | - Lady G. Ramirez
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | - Jorge E. Duque
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | | | - Mary D. Fiel-Gan
- Department of Pathology, Hartford Hospital, Hartford, Connecticut, United States of America
| | | | - Rodolfo Trujillo
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | - Carlos Valencia
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | - Linda Jagodzinski
- Walter Reed Army Institute of Research, Rockville, Maryland, United States of America
| | - David L. Cox
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Justin D. Radolf
- Department of Medicine, University of Connecticut Health Center, Farmington, Connecticut, United States of America
- Department of Genetics and Developmental Biology, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - Juan C. Salazar
- Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut, United States of America
- Division of Infectious Diseases, Connecticut Children's Medical Center, Hartford, Connecticut, United States of America
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Naraghi AM, Salonen DC, Bloom JA, Becker EJ. Magnetic resonance imaging features of osseous manifestations of early acquired syphilis. Skeletal Radiol 2010; 39:305-9. [PMID: 19795120 DOI: 10.1007/s00256-009-0806-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 08/28/2009] [Accepted: 09/14/2009] [Indexed: 02/02/2023]
Abstract
We report the case of a 64-year-old man who initially presented with a maculopapular rash followed several weeks later by bilateral shin pain and infiltrative cutaneous lesions over the lower legs. The plain radiographs were not contributory, and the patient was referred for a whole-body bone scan, which demonstrated multifocal osseous lesions, including such lesions in the lower legs, skull and facial bones. Magnetic resonance imaging (MRI) demonstrated numerous small tibial and fibular nodular lesions involving the medullary cavity and the cortex. A diagnosis of acquired syphilis was made, based on skin biopsy. Results of serological testing were consistent with recent infection. The patient was treated with intramuscular injection of penicillin, and follow-up MRI demonstrated gradual resolution of the osseous lesions. Bone involvement is a relatively rare manifestation of early acquired syphilis. Although the plain radiographic features of the bony changes in acquired syphilis are well documented, there have been no reports of the magnetic resonance imaging findings in the appendicular skeleton.
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Affiliation(s)
- Ali M Naraghi
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, Toronto, ON, Canada.
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Dinotta F, De Pasquale R, Micali G. Secondary syphilis with exclusive peno-scrotal localization. GIORN ITAL DERMAT V 2009; 144:725-728. [PMID: 19907410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Syphilis is a sexually transmitted disease, caused by Treponema pallidum subspecies pallidum, its incidence, in the last decade, has significantly increased both in Western World and in developing countries. It represents a global health problem: it is estimated that each year the new cases of syphilis account for about 12 millions. The diagnosis is not always easy, especially in secondary syphilis in which the cutaneous manifestations are quite variable and should be considered in the differential diagnosis. A 26-year-old homosexual man had from some days papular lesions in the scrotum and penis. Four months before he had consulted a surgeon for the presence of an ulcerated nodular lesion in the perianal area, which advised to remove it in the suspicion of cancer. The patient declined surgery while observing in the following weeks a gradual and complete disappearance of the lesion. On the basis of clinical history, clinical features and laboratory results, a diagnosis of secondary syphilis with an exclusive peno-scrotal localization was made and systemic therapy with diaminocillin was started that led to complete resolution of skin lesions and to significant reduction of sierologic values.
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Affiliation(s)
- F Dinotta
- Dermatologic Clinic, University of Catania, University Hospital G. Rodolico Policlinic, Catania, Italy.
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29
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Ibsen HHW. [Picture of the month: skin syphilis]. Ugeskr Laeger 2009; 171:1299. [PMID: 19416626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Gagari E, Stephanaki C, Rozakou A, Stauropoulos P, Perogianni K, Hadjivassiliou M. Atypical presentation of secondary syphilis in a psoriatic HIV patient. Int J STD AIDS 2009; 20:291-2. [PMID: 19304984 DOI: 10.1258/ijsa.2009.009021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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31
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Zofío E, Conde-Salazar L, Heras F. [Disseminated nodulo-squamous syphilide]. Actas Dermosifiliogr 2008; 99:569-570. [PMID: 18682173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- Enrique Zofío
- Clínica del Dr. Olavide. Sala 5. feminine, cama n. masculine 13
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32
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Lombardo PC. Keratoderma blennorrhagicum-like rash. N Engl J Med 2008; 359:974; author reply 974. [PMID: 18753658 DOI: 10.1056/nejmc081306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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33
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Affiliation(s)
- Ivan Tonna
- Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, Scotland
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34
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Worm AM, Hadjivassiliou M, Katsambas A. Syphilis depicted by the Greek moulages: a picture of skin manifestations in former times. J Eur Acad Dermatol Venereol 2007; 21:1234-8. [PMID: 17894711 DOI: 10.1111/j.1468-3083.2007.02247.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A great part of the medical wax moulages produced in the beginning of the last century depicts the various clinical signs of syphilis. Based on the study of a large Greek moulage collection, the different stages of syphilis are described. Moulages may still have the original scope as teaching objects, presenting clinical manifestations seldom seen to day and thus more likely of being overseen by the clinicians.
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Affiliation(s)
- A-M Worm
- Medical Center for Specialists, Copenhagen, Denmark.
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35
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36
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Clyti E, dos Santos RB. [Endemic treponematoses in Maputo, Mozambique]. Bull Soc Pathol Exot 2007; 100:107-8. [PMID: 17727031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Endemic treponematoses are present in inter-tropical countries in Africa, America, Indonesia and Papua New Guinea. Epidemiology and transmission of the disease are well known. After eradication in some countries after mass treatment in 1950-60, a resurgence of endemic treponematoses has been reported since 1980-90. We present 2 cases of endemic syphilis from the dermatology unit of the Maputo hospital, the first to be described in Mozambique. The endemic syphilis was probably facilitated by the social conditions induced by the Mozambican civil war between 1975 and 1993.
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Affiliation(s)
- E Clyti
- Service de Dermatologie, Centre Hospitalier de Cayenne, France.
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37
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Spornraft-Ragaller P, Boashie U, Friedrich K, Lehmann U, Meurer M. [Late secondary syphilis with ulceration of the tongue during HIV coinfection: case report]. Hautarzt 2007; 57:1005-8. [PMID: 17051406 DOI: 10.1007/s00105-006-1238-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
With the continuing rise of syphilis incidence, late stages and atypical courses with HIV-coinfection can be expected. A 45 year old HIV infected male presented with an unusual manifestation of late secondary syphilis on the tongue, which was first diagnosed as a squamous cell carcinoma but cleared after therapy with penicillin. He also exhibited psoriasiform and annular lesions on the trunk and hyperkeratotic papules on the palms of the hand and soles of the feet. A TPHA test was negative due to a prozone phenomenon. With this case, we would like to emphasize the formerly well known relationship between the lesions of tertiary syphilis on the tongue and development of secondary carcinoma.
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Affiliation(s)
- P Spornraft-Ragaller
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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38
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Abstract
A 38-year-old man with HIV infection presented with panuveitis, urethritis, and a papulosquamous eruption on his palms and soles. Careful physical and laboratory examination led to the diagnosis of syphilitic keratoderma, uveitis, and balanitis. The patient was successfully treated with penicillin and prednisone therapy. Because the initial presentation was difficult to distinguish from the symptoms of Reiter's syndrome, a high degree of clinical suspicion was required to accurately diagnose syphilis, a curable and potentially fatal disease.
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Affiliation(s)
- Mitsumasa Kishimoto
- Division of Rheumatology, NYU School of Medicine/Hospital for Joint Diseases, New York, New York; Department of Public Health, Juntendo University, Tokyo, Japan..
| | - Adam Mor
- Division of Rheumatology, NYU School of Medicine/Hospital for Joint Diseases, New York, New York
| | - Aryeh M Abeles
- Division of Rheumatology, NYU School of Medicine/Hospital for Joint Diseases, New York, New York
| | - Gary Solomon
- Division of Rheumatology, NYU School of Medicine/Hospital for Joint Diseases, New York, New York
| | - Michael H Pillinger
- Division of Rheumatology, NYU School of Medicine/Hospital for Joint Diseases, New York, New York
| | - Maryann J Lee
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, New Jersey
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39
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Wu CC, Tsai CN, Wong WR, Hong HS, Chuang YH. Early congenital syphilis and erythema multiforme-like bullous targetoid lesions in a 1-day-old newborn: detection of Treponema pallidum genomic DNA from the targetoid plaque using nested polymerase chain reaction. J Am Acad Dermatol 2006; 55:S11-5. [PMID: 16843116 DOI: 10.1016/j.jaad.2005.11.1062] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Revised: 11/15/2005] [Accepted: 11/15/2005] [Indexed: 11/20/2022]
Abstract
A 1-day-old male newborn was born with respiratory distress, low birth weight, hepatosplenomegaly, and bullous targetoid skin lesions over the face, back, buttocks, and extremities. A diagnosis of early congenital syphilis was made based on a treponemal serologic test. Pathologic examination of the skin lesion showed scattered dyskeratotic cells in the epidermis and interface dermatitis consistent with erythema multiforme. No spirochete could be found in the skin sections staining with Warthin-Starry stain. Using nested polymerase chain reaction, treponemal genomic DNA fragments encoding DNA polymerase I were detected.
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Affiliation(s)
- Chao-Chang Wu
- Department of Dermatology, Chang Gung Memorial Hospital, Taipei, Taiwan
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40
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Affiliation(s)
- R F Davis
- Departments of Dermatology, Leicester Royal Infirmary, Leicester, UK.
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41
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Erfurt C, Lueftl M, Simon M, Schuler G, Schultz ES. Late syphilis mimicking a pseudolymphoma of the skin. Eur J Dermatol 2006; 16:431-4. [PMID: 16935805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2006] [Indexed: 05/11/2023]
Abstract
After a period of declining incidence of syphilis in most of Western Europe until the late 1990s, reports about an increasing trend have been published recently. In contrast to the rising incidence of early syphilis, cases of late (tertiary) syphilis are rarely seen in developed countries. In this report, we describe a 54-year-old patient with infiltrated erythematous plaques on his forehead and neck that histologically revealed a dense lymphocytic cell infiltrate with numerous plasma cells. The serologic examination was characteristic of syphilis and in conjunction with the clinical presentation and the patient's history led to the diagnosis of tertiary syphilis. The diagnosis of this late stage of syphilis can be difficult as clinical pictures can be misleading. Peculiar skin lesions should always remind clinicians of this infectious disease which has still to be considered in differential diagnoses in dermatology.
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Affiliation(s)
- Cornelia Erfurt
- Department of Dermatology, University Hospital Erlangen, Hartmannstrasse 14, 91052 Erlangen, Germany.
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42
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Giuliani M, Latini A, Palamara G, Maini A, Di Carlo A. The clinical appearance of pinta mimics secondary syphilis: another trap of treponematosis? Clin Infect Dis 2006; 40:1548; author reply 1548-9. [PMID: 15844083 DOI: 10.1086/429726] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Affiliation(s)
- M Singh
- Department of Sexual Health, Homerton Hospital, London, UK.
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44
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Affiliation(s)
- Sumi G So
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9073, USA.
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45
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Affiliation(s)
- Ncoza C Dlova
- Department of Dermatology, Nelson R. Mandela School of Medicine, Durban, South Africa
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46
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ul Bari A, Raza N. Secondary syphilis clinically mimicking pseudolymphoma of the face. Dermatol Online J 2006; 12:20. [PMID: 16638434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
Syphilis has been given titles such as the great imitator, the great mimic, and the great masquerader. It may lack pathognomonic signs and often presents similar to many other dermatological conditions. We present a case of a young woman who developed asymptomatic papulonodular lesions on the forehead; the lesions were clinically similar to pseudolymphoma but it was determined that she had secondary syphilis exhibiting prozone phenomenon. She also had alopecia of eyebrows. Both the alopecia as well as nodular lesions clinically resembling pseudolymphoma responded to and completely recovered with antisyphilitic treatment.
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Kang SH, Lee D, Park JH, Kang MS, Cho SH, Park SW. Scrotal eczema-like lesion of secondary syphilis in an HIV-positive patient. Acta Derm Venereol 2006; 85:536-7. [PMID: 16396809 DOI: 10.1080/00015550510037666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022] Open
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48
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Emmert S, Steinhoff M, Günzl HJ, Rünger TM. [Persistent plaque on the back and right upper arm. Latent syphilis (lues III) with tubero-ulcero-serpiginous plaque]. J Dtsch Dermatol Ges 2006; 4:156-9. [PMID: 16503944 DOI: 10.1111/j.1610-0387.2006.05905.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Steffen Emmert
- Abteilung Dermatologie und Venerologie Universitäts-Hautklinik, Georg-August-Universität Göttingen, Germany.
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49
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Metta H, Corti M, Pizzariello G, de Carolis L. [Disseminated maculopapular rash in a patient with AIDS]. Enferm Infecc Microbiol Clin 2005; 23:571-2. [PMID: 16324571 DOI: 10.1157/13080269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Humberto Metta
- Hospital de Enfermedades Infecciosas Francisco J. Muñiz, Buenos Aires, Argentina.
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50
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Grossberg EB, Hunek JR, Chaffins ML. Noduloulcerative lesions on the trunk and face. ACTA ACUST UNITED AC 2005; 141:1311-6. [PMID: 16230570 DOI: 10.1001/archderm.141.10.1311-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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