The Great Impostor: Transaminitis Masking the Coinfection of Syphilis and Human Immunodeficiency Virus

Introduction. The incidence of syphilis continues to rise in the United States over the past 15 years. This disease process is classified into stages and may present with a coinfection of Human Immunodeficiency Virus (HIV).Case Report. We present a case of a 32-year-old African American male who presented with cutaneous manifestations of secondary syphilis and transaminitis. A workup revealed that the transaminitis was secondary to underlying syphilitic hepatitis in the presence of HIV coinfection. The patient had a reactive rapid plasma reagin (RPR) of 1 : 64 TU and reactiveTreponema pallidumparticle agglutination assay (TPPA). Lab findings showed alkaline phosphate (ALP) of 648 unit/L, aspartate aminotransferase (AST) of 251 unit/L, and alanine aminotransferase (ALT) of 409 unit/L.Conclusion. Syphilitic hepatitis is a recognized entity in the medical literature. It is a manifestation of secondary syphilis and it is more commonly seen in coinfected patients with both syphilis and HIV. Therefore, primary care physicians should keep infectious etiologies (e.g., syphilis and HIV) in the differential diagnosis of patients who present with unexplained liver dysfunction in a cholestatic pattern.

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Unusual manifestations of secondary syphilis and abnormal humoral immune response to Treponema pallidum antigens in a homosexual man with asymptomatic human immunodeficiency virus infection

Journal of the American Academy of Dermatology ◽

10.1016/s0190-9622(88)70062-6 ◽

1988 ◽

Vol 18 (2) ◽

pp. 423-428 ◽

Cited By ~ 68

Author(s):

Justin D. Radolf ◽

Richard P. Kaplan

Keyword(s):

Immune Response ◽

Human Immunodeficiency Virus ◽

Virus Infection ◽

Human Immunodeficiency Virus Infection ◽

Humoral Immune Response ◽

Treponema Pallidum ◽

Secondary Syphilis ◽

Humoral Immune ◽

Immunodeficiency Virus ◽

Asymptomatic Human Immunodeficiency Virus

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Secondary Syphilis in Human Immunodeficiency Virus (HIV)-Infected Men Who Have Sex with Men (MSM): A Case Report

Berkala Ilmu Kesehatan Kulit dan Kelamin ◽

10.20473/bikk.v32.1.2020.75-84 ◽

2020 ◽

Vol 32 (1) ◽

pp. 75

Author(s):

Ade Fernandes ◽

Evy Ervianti

Keyword(s):

Human Immunodeficiency Virus ◽

Treatment Success ◽

Venereal Disease ◽

Treponema Pallidum ◽

Clinical Manifestations ◽

Secondary Syphilis ◽

Response To Treatment ◽

Immunodeficiency Virus ◽

Tertiary Stage ◽

Sex With Men

Background: Recently, the incidence of syphilis among men who have sex with men (MSM) has increased rapidly, especially among Human Immunodeficiency Virus (HIV)-infected MSM. Coinfection with these two organisms alter the symptoms and signs, progression of the disease, and the risk of progressing to the tertiary stage. Purpose: To report a case of secondary syphilis in HIV-infected MSM. Case: A 24-year-old male complaint of multiple redness macule for 1-month duration on his chest, back, groin, palm, and soles. The rash was neither painful nor pruritic. He also complains of hair loss resulting "moth eaten" alopecia. One month before, he had a painless ulcer on his genital, which resolved without treatment. His HIV infection was diagnosed two years earlier. He had been sexually active with multiple homosexual partners without using a condom since 2010. The Venereal Disease Research Laboratory test (VDRL) titer was 1/32, and Treponema pallidum haemagglutination assay (TPHA) was 1/20480. Initial treatment was a single dose of 2.4 million units of benzathine penicillin. Serologic examination was reevaluated on month 1, 3, 6, and 9 after therapy and declined in the third month. Discussion: For HIV-infected persons, the clinical manifestations of syphilis in most of the cases remain the same. However, the lesions are more aggressive, and coexistence of primary and secondary syphilis is more frequent. Serologic tests are accurate and reliable for the diagnosis and for following a patient’s response to treatment. Penicillin is effective but physical and serological follow up is needed. Conclusion: HIV-infected MSM have higher risk of syphilis. Staging is needed to determine the treatment. Serologic examination should be repeated and long enough to monitor the treatment success.

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CONDYLOMA LATA IN A 21-YEAR-OLD MALE TREATED WITH DOXYCYCLINE: A CASE REPORT

JURNAL BIOMEDIK (JBM) ◽

10.35790/jbm.6.2.2014.5555 ◽

2014 ◽

Vol 6 (2) ◽

Author(s):

Hendra Minarto

Keyword(s):

Human Immunodeficiency Virus ◽

Risk Factor ◽

Case Report ◽

Hiv Transmission ◽

Treponema Pallidum ◽

Initial Therapy ◽

Secondary Syphilis ◽

Immunodeficiency Virus ◽

The World

Abstrak: Kondiloma lata merupakan salah satu manifestasi sifilis sekunder yang disebabkan oleh Treponema pallidum. Manifestasi klinis kondiloma lata berupa papul-papul berwarna putih atau keabuan pada daerah tubuh yang hangat dan lembab. Sifilis memerlukan perhatian serius karena penyakit ini merupakan salah satu faktor risiko transmisi human immunodeficiency virus (HIV) di seluruh dunia. Kami melaporkan satu kasus kondiloma lata pada seorang laki-laki berusia 21 tahun di daerah penis, skrotum, perineal, dan perianal sejak 2 bulan lalu, yang diterapi dengan doksisiklin 2 x 100 mg selama 30 hari. Pada pemeriksaan serologik awal didapatkan hasil reaktif untuk tes VDRL (1/256), tes RPR (1/512) dan tes TPHA (1/5120). Perbaikan signifikan terlihat setelah 30 hari terapi doksisiklin dimana semua lesi menghilang. Pemeriksaan serologik 3 bulan setelah awal terapi menunjukkan penurunan titer sebanyak empat kali lipat untuk tes VDRL (1/64), tes RPR (1/128), dan enam kali lipat untuk tes TPHA (1/640). Simpulan: Telah dilaporkan kasus kondiloma lata dengan diagnosis ditegakkan berdasarkan anamnesis, pemeriksaan fisik, dan serologik. Terapi doksisiklin selama 30 hari memberikan hasil yang memuaskan. Pemeriksaan serologik harus dilakukan pada bulan ke-6 dan 12 untuk monitoring keberhasilan terapi. Kata kunci: kondiloma lata, sifilis sekunder, Treponema pallidum, doksisiklin Abstract: Condyloma lata is one manifestation of secondary syphilis caused by Treponema pallidum. It is described clinically as multiple whitish or gray papules found in warm and moist areas. Syphilis requires serious attention since it still remains a risk factor of human immunodeficiency virus (HIV) transmission all around the world. We reported a case of a 21-year-old male suffered from condyloma lata on his penile, scrotal, perineal, and perianal regions for 2 months and treated with 30 days course of 100 mg doxycyline two times daily. Early serologic examinations revealed reactive values of VDRL test (1/256), RPR test (1/512), and TPHA test (1:5120). Significant improvement was observed after 30 days course of doxycyline therapy where all lesions have resolved. Further serologic examinations as follow up showed a fourfold titre decrease of VDRL test (1/64), RPR test (1/128) and sixfold titre decrease of TPHA test (1/640) 3 months after the initial therapy. Conclusion: The diagnosis of condyloma lata in this case was established based on anamnesis, physical examination, and serologic findings. Treatment with doxycycline gave satisfactory result. Serologic examination as follow up needs to be performed at 6 and 12-months after the initial treatment to monitor the success of therapy. Keywords: condyloma lata, secondary syphilis, Treponema pallidum, doxycycline.

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Syphilis? An Unusual Cause of Surgical Emergency in a Human Immunodeficiency Virus-Infected Man

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv094 ◽

2015 ◽

Vol 2 (3) ◽

Author(s):

Rachel A. Bender Ignacio ◽

Lisa L. Koch ◽

Shireesha Dhanireddy ◽

B. Charmie Godornes ◽

Sheila A. Lukehart ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Polymerase Chain Reaction ◽

Treponema Pallidum ◽

Secondary Syphilis ◽

Anorectal Surgery ◽

Chain Reaction ◽

Surgical Emergency ◽

Immunodeficiency Virus ◽

Polymerase Chain ◽

Anorectal Pathology

Abstract We report on a human immunodeficiency virus-infected man undergoing urgent anorectal surgery, with multi-centimeter fungating masses discovered inside the anus. Initial pathology was inconclusive. After the patient developed a disseminated rash postoperatively determined to be secondary syphilis, the anorectal pathology was reviewed and Treponema pallidum DNA was amplified by polymerase chain reaction from the mass.

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