Pathologically Confirmed Malignant Syphilis in an HIV-Infected Patient

Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, Japan.
Internal Medicine (Impact Factor: 0.9). 01/2011; 50(20):2423-6. DOI: 10.2169/internalmedicine.50.5605
Source: PubMed


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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    • "The cutaneous manifestations that characterize secondary syphilis are usually superficial and include four major types of rashes: macular, papular, papulosquamous, and pustular [4]. Hyperkeratotic, crusted limpet like and discolored lesions called rupia are rare and have been seen in relapsing secondary syphilis [7] and in several other situations, most of which involve varied degrees of immunesuppression, including HIV, malnutrition, pregnancy, or diabetes [8]. In the present report, we described a case with an appearance similar to that of a rupioid psoriatic skin lesion and associated knee joint symptoms occurring in an immunocompetent elderly male patient with serology confirmed syphilis and immunohistochemistry proved positive spirochetes in his skin lesions. "
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    ABSTRACT: Background The incidence of syphilis is increasing in many parts of the world. Clinicians may have limited experience in the diagnosis when the clinical appearance is unusual. If early diagnosis is not made and prompt treatment not given, then the disease may remain quiescent until more serious symptoms or systemic involvement develops. Case presentation We report the first case of a delayed diagnosis of syphilis with a ten-year history of persistent rupioid psoriasis-like lesions. Acute monoarthritis and high fever together with aggravation of skin lesions led to a careful clinical examination. Skin biopsies demonstrated syphilis spirochetes on immunohistochemical stain, and syphilis serological titers were positive. Standard treatment with benzathine penicillin brought a partial and transient improvement. A complete clinical and serological resolution of the disease was achieved by a prolonged and repeated penicillin treatment combined with methylprednisolone. A 7-year follow-up of the patient proved a full recovery. Conclusion Our case highlights the fact that clinical signs of syphilis can be diverse and complicated. Unusual clinical manifestations can happen in an immunocompetent individual. Treatment strategy may need to be adjusted in a difficult case.
    BMC Infectious Diseases 12/2012; 12(1):338. DOI:10.1186/1471-2334-12-338 · 2.61 Impact Factor
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    ABSTRACT: La sífilis maligna es una forma rara de presentación de lúes secundaria asociada a la infección por el virus de la inmunodeficiencia humana (VIH). Se caracteriza por lesiones cutáneas atípicas, ulceradas, costrosas y diseminadas, asociadas con síntomas generales inespecíficos que pueden retrasar el diagnóstico correcto. Existen sólo escasas publicaciones en la literatura médica acerca de sífilis maligna en pacientes con infección por VIH. La lúes maligna debe incluirse en el diagnóstico diferencial de los pacientes con VIH que consultan por fiebre y lesiones úlcero-costrosas diseminadas. Se describe el caso de un paciente con infección por VIH que desarrolló una sífilis maligna con confirmación diagnóstica a partir de los hallazgos histopatológicos y se realiza una revisión de la literatura científica sobre el tema.
    Revista chilena de infectologia: organo oficial de la Sociedad Chilena de Infectologia 12/2012; 29(6):678-681. DOI:10.4067/S0716-10182012000700017 · 0.49 Impact Factor
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    ABSTRACT: Malignant syphilis is a rare form of secondary syphilis strongly associated with human immunodeficiency virus infection (HIV). This clinical form of the disease is characterized by atypical cutaneous ulcerative and disseminated lesions and systemic compromise that can delay the final diagnosis. There are only few reports in the medical literature about malignant lues in HIV-infected patients. Malignant syphilis should be considered in the differential diagnosis in HIV-infected patients with fever and ulcerative skin lesions. Here we describe a man who developed clinical cutaneous and systemic manifestations pathologically conirmed as malignant syphilis and we performed a review of the literature.
    Revista chilena de infectologia: organo oficial de la Sociedad Chilena de Infectologia 12/2012; 29(6):678-81. DOI:10.1590/S0716-10182012000700017 · 0.49 Impact Factor
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