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.

Unusual presentation of secondary syphilis: membranoproliferative glomerulonephritis andmuco-cutaneous lesions

2017 ◽  
Vol 29 (4) ◽  
pp. 410-413 ◽  
Author(s):  
Linda Tognetti ◽  
Elisa Cinotti ◽  
Sergio Tripodi ◽  
Guido Garosi ◽  
Pietro Rubegni
Keyword(s):  
Membranoproliferative Glomerulonephritis ◽  
Congenital Syphilis ◽  
Renal Involvement ◽  
Treponema Pallidum ◽  
Membranous Glomerulonephritis ◽  
Secondary Syphilis ◽  
Cutaneous Lesions ◽  
Syphilis Infection ◽  
Cutaneous Manifestations ◽  
Nephritic Syndrome

The worldwide re-emergence of secondary syphilis which happened in the last decade, has led to an increase in primary and secondary syphilis cases, along with the presentation of atypical forms. Nevertheless, reports of renal syphilis with mucosal and/or cutaneous manifestations are nowadays increasing. Typically, secondary syphilis infection in adults causes nephrotic syndrome due to a membranous glomerulonephritis. Here, we report a case of a 30-year-old immunocompetent man presenting with skin rash, oral and perianal erosions and nephritic syndrome. Laboratory investigations revealed a form of membranoproliferative glomerulonephritis secondary to Treponema pallidum infection. Therapy with benzathine penicillin brought prompt and complete remission of the disease. Although well described for congenital syphilis, this histopathologic pattern of renal involvement is very rarely reported in adult patients. In case of detection of an otherwise unexplained nephritic syndrome in sexually active patients with mucosal and/or anal lesions, an unrecognized syphilis infection should be suspected.

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.  

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 Secondary syphilis: The great imitator can't be forgotten

2017 ◽  
Vol 63 (6) ◽  
pp. 481-483 ◽  
Author(s):  
Clarissa Prieto Herman Reinehr ◽  
Célia Luiza Petersen Vitello Kalil ◽  
Vinícius Prieto Herman Reinehr
Keyword(s):  
Lichen Planus ◽  
Treponema Pallidum ◽  
Daily Practice ◽  
Secondary Syphilis ◽  
Sexual Contact ◽  
Cutaneous Manifestations ◽  
Mucocutaneous Lesion

Summary Syphilis is an infection caused by Treponema pallidum, mainly transmitted by sexual contact. Since 2001, primary and secondary syphilis rates started to rise, with an epidemic resurgence. The authors describe an exuberant case of secondary syphilis, presenting with annular and lichen planus-like lesions, as well as one mucocutaneous lesion. Physicians must be aware of syphilis in daily practice, since the vast spectrum of its cutaneous manifestations is rising worldwide.

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.

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 Papulonodular Secondary Syphilis Presenting as Multiple Distinct Cutaneous Lesions in an HIV-Positive Transgender Woman

2017 ◽  
Vol 9 (1) ◽  
pp. 90-94 ◽  
Author(s):  
Kristina Navrazhina ◽  
Brienne D. Cressey ◽  
Kira Minkis
Keyword(s):  
Early Diagnosis ◽  
Secondary Syphilis ◽  
Diagnosis And Treatment ◽  
Hiv Positive ◽  
Cutaneous Lesions ◽  
Cutaneous Manifestations

We present the first reported case of papulonodular secondary syphilis in an HIV-positive transgender female. Syphilis is classified into primary, secondary, latent, and tertiary stages, with secondary syphilis having notably diverse cutaneous manifestations. Our patient presented with diverse lesions throughout her body, all pathologically consistent with papulonodular secondary syphilis. Proper identification of the multiple presentations of syphilis is crucial to early diagnosis and treatment. This report seeks to broaden the scope of dermatological manifestations that arise secondary to papulonodular syphilis in HIV-positive patients.

Secondary syphilis mimicking tuberculoid leprosy in an HIV-positive individual: a case report

2019 ◽  
Vol 30 (12) ◽  
pp. 1235-1238
Author(s):  
D Fernandez-Nieto ◽  
D Ortega-Quijano ◽  
J Jimenez-Cauhe ◽  
P Fernandez-Gonzalez ◽  
E Moreno-Moreno ◽  
...  
Keyword(s):  
Correct Diagnosis ◽  
Treponema Pallidum ◽  
Secondary Syphilis ◽  
Diagnostic Challenge ◽  
Positive Individual ◽  
Mucosal Involvement ◽  
Immunodeficiency Virus ◽  
Granulomatous Lesions ◽  
Tuberculoid Leprosy ◽  
Common Manifestation

Secondary syphilis is a polymorphic condition resulting from the hematogenous and lymphatic dissemination of Treponema pallidum. Human immunodeficiency virus-positive patients are in greater risk of atypical and severe forms of the disease. The most common manifestation is a generalized papulosquamous eruption with variable mucosal involvement. However, annular plaques, split commissural papules, crusted necrotic or ulcerated lesions are also frequent. Granulomatous lesions, both clinically and histologically, are less common and present a diagnostic challenge. We describe a case of secondary syphilis presenting as a granulomatous rash with both clinical and histological features of tuberculoid leprosy. Complementary tests and clinical suspicion are essential to ensure a correct diagnosis and avoid subsequent complications.

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