A case of secondary syphilis with pulmonary involvement and review of the literature

2018 ◽  
Vol 29 (10) ◽  
pp. 1027-1032 ◽  
Author(s):  
Suttichai Visuttichaikit ◽  
Nuntra Suwantarat ◽  
Anucha Apisarnthanarak ◽  
Pansachee Damronglerd
Keyword(s):  
Treponema Pallidum ◽  
Clinical Signs ◽  
Systemic Infection ◽  
Final Diagnosis ◽  
Pulmonary Involvement ◽  
Needle Aspiration ◽  
Secondary Syphilis ◽  
Lung Abscess ◽  
Penicillin G ◽  
Amoxicillin Clavulanate

Syphilis is a sexually transmitted systemic infection caused by Treponema pallidum. We report a case of a heterosexual, HIV-positive man who presented with secondary syphilis and a lung abscess. A bacterial lung abscess was suspected and a computed tomography-guided percutaneous needle aspiration of the lung abscess was performed. Direct pulmonary involvement by T. pallidum was suggested by a positive PCR result on the aspirated fluid specimen. The clinical signs of secondary syphilis improved, and the lung abscess was resolved after treatment with benzathine penicillin G and amoxicillin-clavulanate. The final diagnosis was secondary pulmonary syphilis. Few reports of secondary syphilis with pulmonary involvement have been reported to date.

scholarly journals Sexual abuse leading to secondary syphilis in an intellectually disabled person: a case report

2021 ◽  
Vol 7 (6) ◽  
pp. 872
Author(s):  
Rajesh Munusamy ◽  
Nithin Nagaraja
Keyword(s):  
Sexual Abuse ◽  
Venereal Disease ◽  
Treponema Pallidum ◽  
Secondary Syphilis ◽  
Penicillin G ◽  
Intellectually Disabled ◽  
Transmitted Infection ◽  
Sexual Transmitted Infection ◽  
Benzathine Penicillin G

<p class="abstract">Syphilis is a sexual transmitted infection (STI) caused by a spirochete, <em>Treponema pallidum</em>. Condylomata lata is a characteristic lesion seen in secondary syphilis. Here we reported a case of 24 year old unmarried male with intellectual disability who presented with condyloma lata over the scrotum, prepuce and perianal region and with moth eaten alopecia over scalp since 1 month. Here the patients mother revealed he had promiscuous relationship with multiple friends, which is a sexual abuse since the patient is intellectually disabled. Clinically diagnosed as secondary syphilis. Venereal disease research laboratory (VDRL) test titre was reactive at 1:32 and <em>Treponema pallidum </em>hemagglutination test (TPHA) was positive. Biopsy was also done, which confirmed diagnosis. Single dose of injection benzathine penicillin G, 2.4 million units was administered intramuscularly. Patient did not develop a Jarisch-herxheimer reaction. On follow up his lesions healed and VDRL titres also came down and non-reactive at 3 months. Here in this case sexual abuse lead to secondary syphilis since patient was intellectually disabled so he couldn’t address his complaints clearly. Hence counselling was done to the patient and family members by dermatologist and psychiatrist.</p><p class="abstract"> </p>

Secondary syphilis presenting as erythema multiforme in a HIV-positive homosexual man: a case report and literature review

2018 ◽  
Vol 30 (3) ◽  
pp. 304-309
Author(s):  
Hongfang Liu ◽  
Beng-Tin Goh ◽  
Taoyuan Huang ◽  
Yinghui Liu ◽  
Ruzeng Xue ◽  
...  
Keyword(s):  
Plasma Cell ◽  
Erythema Multiforme ◽  
Treponema Pallidum ◽  
Inflammatory Cells ◽  
Secondary Syphilis ◽  
Penicillin G ◽  
Cell Infiltrate ◽  
Early Syphilis ◽  
Skin Histology ◽  
Anal Warts

Early syphilis can rarely cause erythema multiforme-type eruptions as well as triggering erythema multiforme (EM). EM-like lesions in secondary syphilis are characterized by clinical features of EM and laboratory tests consistent with secondary syphilis and the skin histology shows predominantly a plasma cell infiltrate with the presence of treponemes. When EM is triggered by early syphilis, the skin histology shows mixed inflammatory cells usually in the absence of treponemes in the skin lesion. There may also be mixed histology with the presence of treponemes in the absence of a plasma cell infiltrate and vice versa. We describe a case of secondary syphilis presenting as EM with bullae and histology showing EM features without a plasma cell infiltrate but positive for Treponema pallidum by immunohistochemical staining. The patient was also coinfected with cytomegalovirus, human immunodeficiency virus, and anal warts. The EM eruptions resolved with treatment for secondary syphilis with benzathine penicillin G.

scholarly journals Double Morphology: Tertiary Syphilis and Acquired Immunodeficiency Syndrome—A Rare Association

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
R. M. Ngwanya ◽  
B. Kakande ◽  
N. P. Khumalo
Keyword(s):  
Past History ◽  
Treponema Pallidum ◽  
Secondary Syphilis ◽  
Penicillin G ◽  
Rapid Progression ◽  
Tertiary Syphilis ◽  
History Of ◽  
Generalized Lymphadenopathy ◽  
Immunodeficiency Syndrome ◽  
Cluster Of Differentiation

Background. Human immunodeficiency virus (HIV) and Treponema pallidum coinfection is relatively common and accounts for about 25% of primary and secondary syphilis. Tertiary syphilis in HIV-uninfected and HIV-infected patients is vanishingly rare. This is most likely due to early treatment of cases of primary and secondary syphilis. There is rapid progression to tertiary syphilis in HIV-infected patients. Case Presentation. A 49-year-old woman diagnosed with HIV Type 1 infection and cluster of differentiation 4 (CD4) count of 482 presented with a four-week history of multiple crusted plaques, nodules, and ulcers on her face, arms, and abdomen. Her past history revealed red painful eyes six months prior to this presentation. She had generalized lymphadenopathy, no alopecia, and no palmar-plantar or mucosal lesions. There were no features suggestive of secondary syphilis. Neurological examination was normal. Her rapid plasma reagin test was positive to a titer of 64. She was treated with Penicillin G 20 mu IVI daily for 2 weeks. Conclusion. Penicillin remains the treatment of choice in syphilitic infected HIV negative and HIV-infected individuals. In neurosyphilis, the dose of Penicillin GIVI is 18–24 mu daily for 10–14 days. This case report demonstrates the importance of excluding syphilis in any HIV-infected patient.

scholarly journals Exploring the Ways of “The Great Imitator”: A Case Report of Syphilitic Hepatitis

2021 ◽  
pp. 1-4
Author(s):  
João A. Cunha Neves ◽  
Joana Roseira ◽  
Helena Tavares de Sousa ◽  
Rui Machado
Keyword(s):  
Immune Responses ◽  
Venereal Disease ◽  
Treponema Pallidum ◽  
Maculopapular Rash ◽  
Liver Function Tests ◽  
Secondary Syphilis ◽  
Penicillin G ◽  
Sexually Transmitted ◽  
Patients At Risk ◽  
Mixed Pattern

<b><i>Introduction:</i></b> Syphilis is a chronic infection caused by <i>Treponema pallidum</i>. Manifestations of this disease are vast, and syphilitic hepatitis is a rarely depicted form of secondary syphilis. <b><i>Case Presentation:</i></b> We report the case of a 63-year-old man with worsening jaundice, maculopapular rash and perianal discomfort. Proctological examination with anoscopy revealed a perianal gray/white area with millimetric pale granules along the anal canal. Liver function tests showed a mixed pattern. Venereal Disease Research Laboratory, <i>T. pallidum</i> hemagglutination assay and IgM fluorescent treponemal antibody absorbance were positive. The patient was successfully treated with a single dose of penicillin G. <b><i>Discussion/Conclusion:</i></b> Syphilitic hepatitis is scarcely reported in the literature. Secondary syphilis with mild hepatitis rarely leads to hepatic cytolysis and jaundice. Many signs of secondary syphilis including syphilitic hepatitis may be linked to immune responses initiated during early infection. Over the past decades, evidence has emerged on the importance of innate and adaptive cellular immune responses in the immunopathogenesis of syphilis. This report raises awareness to a clinical entity that should be considered in patients at risk for sexually transmitted diseases, who present with intestinal discomfort or liver dysfunction, as it is a treatable and fully reversible condition.

scholarly journals Empyema and lung abscess: An unusual presentation of pulmonary actinomycosis

2017 ◽  
Vol 4 (2) ◽  
pp. 60
Author(s):  
Matthew A. Robinson ◽  
Avinesh S. Bhar
Keyword(s):  
Chest Tube ◽  
Lower Lobe ◽  
Pulmonary Involvement ◽  
Lung Abscess ◽  
Tube Placement ◽  
Penicillin G ◽  
Computed Tomographic ◽  
History Of ◽  
Artery Disease ◽  
Disseminated Disease

Actinomyces spp. are an infrequent cause of pulmonary infections. Actinomyces spp. comprise part of the normal flora of the oral cavity and gastrointestinal tract. A. meyeri is especially known for pulmonary involvement and disseminated disease. The authors present a case of a polymicrobial pulmonary abscess containing A. meyeri. The patient was a 58-year-old man with a history of coronary artery disease, alcohol abuse and hypertension. He presented with progressive dyspnea and cough productive of grey-colored foul smelling sputum. Upon admission, a chest computed tomographic (CT) scan revealed a right-lower-lobe lung abscess, with an associated loculated empyema. The following day, the patient underwent a thoracostomy with chest tube placement. The chest tube drained several hundred milliliters of purulent pleural fluid, but a follow up chest CT showed little change in the size of the underlying empyema. A subsequent thoracotomy with decortication was performed, which evacuated 100 ml of thick purulent fluid. Fourteen days after admission, the patient was discharged on a 6- to 12-week course of intravenous penicillin G, followed by a 6-month course of oral penicillin V.

scholarly journals Pulmonary Involvement in Secondary Syphilis

2021 ◽  
Author(s):  
Ruben Benainous ◽  
Mohanad Alunji ◽  
Pierre Yves Brillet ◽  
Robin Dhote
Keyword(s):  
Treponema Pallidum ◽  
Pulmonary Nodules ◽  
Pulmonary Involvement ◽  
Secondary Syphilis ◽  
Physical Findings

In secondary syphilis, Treponema pallidum can spread to the lungs. A new case is described of a patient with multiple excavated subpleural pulmonary nodules, a rare localization of secondary syphilis. Despite the numerous pulmonary samples analysed in the literature, T. pallidum is rarely visualised directly on bronchial fibroscopy or biopsy. The diagnosis of secondary syphilis is suspected from historical and physical findings and confirmed by high values obtained from non-treponemal tests.

Secondary syphilis masquerading as lupus vulgaris in an HIV-infected patient: A diagnosis suggested by histology

2018 ◽  
Vol 29 (14) ◽  
pp. 1454-1456 ◽  
Author(s):  
Giovanni Genovese ◽  
Gianluca Nazzaro ◽  
Antonella Coggi ◽  
Raffaele Gianotti ◽  
Stefano Ramoni ◽  
...  
Keyword(s):  
Infected Patient ◽  
Correct Diagnosis ◽  
Treponema Pallidum ◽  
Secondary Syphilis ◽  
Penicillin G ◽  
Lupus Vulgaris ◽  
Cutaneous Lesions ◽  
Current Case ◽  
Cutaneous Manifestations ◽  
Large Plaque

We report a case of secondary syphilis mimicking lupus vulgaris in an HIV-infected patient. A 21-year-old Brazilian man presented with a two-month history of asymptomatic cutaneous lesions accompanied by fever and fatigue. Dermatological evaluation revealed an erythematous, crusted, large plaque on the neck with the ‘apple jelly’ sign on diascopy and two smaller scaly elements on the trunk and left palm. Bacteriological examinations for bacteria and mycobacteria gave negative results. Histology revealed psoriasiform epidermal hyperplasia and dermal lymphoplasmacytic infiltrate. Serology for syphilis was positive, and immunohistochemistry confirmed the presence of Treponema pallidum in lesional skin. A diagnosis of secondary syphilis was made, and the patient was successfully treated with benzathine penicillin G. Cutaneous manifestations of secondary syphilis are protean and skin tuberculosis may be considered in the differential diagnosis, especially in HIV-infected patients. In the current case, clinical examination, and particularly, ‘apple jelly’ sign positivity, was suggestive of lupus vulgaris, but only typical histopathology and immunohistochemistry led to the correct diagnosis of secondary syphilis.

scholarly journals Aseptic Syphilitic Meningitis in an HIV-Negative Patient with Concomitant Primary and Secondary Syphilis

2020 ◽  
Vol 4 (4) ◽  
pp. 361-364
Author(s):  
Antonio Roberto Jimenez ◽  
Paige Hoyer ◽  
Michael Wilkerson
Keyword(s):  
Transmitted Disease ◽  
Treponema Pallidum ◽  
Maculopapular Rash ◽  
Secondary Syphilis ◽  
Penicillin G ◽  
Drug Induced ◽  
Adequate Treatment ◽  
Cutaneous Manifestations ◽  
Dermatology Clinic ◽  
Morbilliform Rash

Background: Syphilis is a sexually and vertically transmitted disease caused by the Treponema pallidum species. Aseptic syphilitic meningitis (ASM) is a subcategory of neurosyphilis. Neurosyphilis is typically considered a tertiary manifestation of syphilis; however, ASM typically occurs within 6 months of exposure and may be concurrent with the rash of secondary syphilis. Case Presentation: A 58-year-old immunocompetent male presented to the dermatology clinic with an erythematous morbilliform rash that involved his trunk and upper extremities. He was prescribed benzonatate 100 mg 3 weeks prior for cough and was diagnosed with a drug-induced morbilliform rash. The patient was seen 1 month later by urology for a penile ulcer. At his urology appointment, an RPR test was done and resulted positive with a titer of 1:256. He was referred to dermatology again and was noted to have a diffuse, copper-colored maculopapular rash involving the palms and soles. During this appointment, the patient complained of a 4-week headache and was found to have nuchal rigidity. He was admitted for neurosyphilis work up, including CSF and CSF-VDRL examination. His neurologic symptoms improved on IV Penicillin G. Repeat RPR testing at 6 months follow up confirmed adequate treatment and his RPR declined from 1:256 to 1:4.  Conclusion: We present a case of ASM in an immunocompetent individual with concomitant primary and secondary syphilis. Dermatologists are trained to recognize the cutaneous manifestations of syphilis, but also should be familiar with the variable presentations of the disease, including the early neurological findings of ASM.  

Pulmonary involvement of secondary syphilis

2017 ◽  
Vol 29 (1) ◽  
pp. 89-91 ◽  
Author(s):  
Yoshihiko Ogawa ◽  
Yuichiro Imai ◽  
Shingo Yoshihara ◽  
Hiroyuki Fujikura ◽  
Nobuyasu Hirai ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chest Pain ◽  
Diagnostic Testing ◽  
Treponema Pallidum ◽  
Clinical Manifestations ◽  
Pulmonary Nodules ◽  
Pulmonary Involvement ◽  
Secondary Syphilis ◽  
Molecular Diagnostic ◽  
Transthoracic Biopsy

Pulmonary involvement in secondary syphilis is considered a rare occurrence; however, the number of cases has increased in the 2000s. This is likely due to the increased use of computed tomography scans and molecular diagnostic testing. We report a case of an HIV-positive man with pleural chest pain and bilateral subpleural nodules on chest computed tomography. His rapid plasma reagin and Treponema pallidum hemagglutination tests were positive, and the specimen of one of the pulmonary nodules obtained by transthoracic biopsy was positive for the polA gene of Treponema pallidum. Since clinical manifestations of syphilis are highly variable, clinicians should bear in mind that pleural chest pain with bilateral subpleural nodules can be caused by pulmonary syphilis.

Retrospective Diagnosis of Pontocerebellar Hypoplasia Type 1B in a Family with Two Deceased Newborn Children

2020 ◽  
Author(s):  
Irena Bradinova ◽  
Silvia Andonova ◽  
Alexey Savov
Keyword(s):  
Clinical Signs ◽  
Final Diagnosis ◽  
Population Based ◽  
Neuromuscular Disorder ◽  
Population Characteristics ◽  
High Risk Population ◽  
Pontocerebellar Hypoplasia ◽  
Clinical Genetic ◽  
Retrospective Diagnosis ◽  
Newborn Children

AbstractPontocerebellar hypoplasia type 1B is a severe autosomal recessive neurologic disorder characterized by a combination of cerebellar and spinal motor neuron degeneration beginning at birth. Pontocerebellar hypoplasia type 1B is caused by mutations in EXOSC3 gene. High prevalence of the p.Gly31Ala mutation was found recently, especially in the Roma ethnic minority. We present a young Bulgarian Roma family with two deceased newborn children manifesting severe neuromuscular disorder including severe muscle weakness, respiratory distress, and multiple joint contractures. Based on the clinical signs and family's population characteristics, DNA testing for the previously described EXOSC3 in Bulgarian Roma mutation c.92G > C; p.Gly31Ala was performed on blood samples of both parents and they were found to be heterozygous carriers. This finding indirectly confirmed the diagnosis of pontocerebellar hypoplasia type B in the deceased offspring. Knowledge of population-specific molecular bases of genetic conditions was the key to final diagnosis in the presented family. Designing of population-based clinical-genetic panels may be a powerful diagnostic tool for patients with such origin. Preconception carrier screening in high-risk population groups is a feasible option to discuss.

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