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 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>

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.

Screening for asymptomatic neurosyphilis in HIV patients after treatment of early syphilis: an observational study

2017 ◽  
Vol 94 (5) ◽  
pp. 337-339 ◽  
Author(s):  
Andrew Tomkins ◽  
Shazaad Ahmad ◽  
Darren E Cousins ◽  
Caroline M Thng ◽  
Francisco Javier Vilar ◽  
...  
Keyword(s):  
Single Dose ◽  
High Risk ◽  
White Blood Cells ◽  
Treponema Pallidum ◽  
Penicillin G ◽  
Oral Antibiotic ◽  
Early Syphilis ◽  
Number Of Patients ◽  
Cd4 Lymphocyte ◽  
Sex With Men

ObjectiveTo determine the prevalence of asymptomatic neurosyphilis (ANS) in HIV-positive individuals after treatment of early syphilis with single-dose benzathine penicillin G (BPG) or oral antibiotic alternatives.MethodsPatients at high risk of neurosyphilis (defined by serum rapid plasma reagin (RPR) titre ≥1:32 and/or peripheral blood CD4 lymphocyte count ≤350/μL) underwent lumbar puncture (LP) at a median time of 8.2 months post treatment. ANS was diagnosed by a reactive cerebrospinal fluid (CSF) RPR test or CSF white blood cells (WBC) >20/μL plus a reactive CSF Treponema pallidum particle agglutination (TPPA) ≥1:640.ResultsOf 133 eligible patients, all were men who have sex with men. Of these, 64 consented to LP. Full CSF results were available for 59 patients. Inclusion criteria were serum RPR (21/59), CD4 count (22/59) and combined RPR and CD4 (16/59). The LP patients were white British (82%), median age 40. Syphilis stages were primary (17%) secondary (43%) and early latent (41%). Syphilis was treated with BPG (47/59), doxycycline 100 mg two times per day for 14 days (10/59) and for 21 days (1/59). Azithromycin 500 mg one time per day for 10 days was given to 1/59. At the time of LP, 100% of patients had achieved serological cure, and 66% were taking antiretroviral treatment. Only 1/59 was diagnosed with ANS. The CSF showed: RPR non-reactive (59/59); TPPA non-reactive in 54/59; WBC ≤5/μL in 51/59.ConclusionsAlthough the number of patients in our study is modest, single-dose BPG appears to be highly effective even in patients at high risk of neurosyphilis.

The Effect of Treatment on the Treponema Pallidum Haemagglutination Test in Early Syphilis

1979 ◽  
Vol 24 (4) ◽  
pp. 307-312 ◽  
Author(s):  
Jennifer M. Hunter
Keyword(s):  
Treponema Pallidum ◽  
Secondary Syphilis ◽  
Post Treatment ◽  
Haemagglutination Test ◽  
Early Syphilis ◽  
Haemagglutination Assay ◽  
Effect Of Treatment ◽  
Pre Treatment ◽  
Latent Syphilis

The response of the Treponema Pallidum Haemagglutination Assay (TPHA) to treatment was studied in 61 cases of early infectious syphilis. In none of the 55 cases of early syphilis in which the pre-treatment TPHA was positive did the TPHA test become consistently negative after treatment. In primary and early latent syphilis it was not possible to demonstrate any significant changes, but in some cases of secondary syphilis a significant and rapidfall in TPHA titre occurred with treatment. It is suggested that the post-treatment TPHA titre need not necessarily reflect the stage at which the disease was arrested.

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.

Erythema multiforme triggered by Treponema pallidum infection in an HIV-infected patient

2017 ◽  
Vol 29 (1) ◽  
pp. 99-102 ◽  
Author(s):  
Luiz GFAB D’Elia Zanella ◽  
Érika F Sampaio ◽  
Rute F Lellis
Keyword(s):  
Erythema Multiforme ◽  
Infected Patient ◽  
Treponema Pallidum ◽  
Clinical Manifestations ◽  
Daily Practice ◽  
Secondary Syphilis ◽  
Positive Patient ◽  
Hiv Positive ◽  
Clinical Conditions

We are currently facing a worldwide epidemic of syphilis. Clinical manifestations that are rarely seen have been encountered, leading the dermatologist to confront unusual clinical conditions in daily practice. Erythema multiforme triggered by syphilis is very rare and is also seldom reported in the literature. We report a case of secondary syphilis in an HIV-positive patient, whose clinical, pathologic and serologic features were consistent with the diagnosis of erythema multiforme triggered by syphilis.

scholarly journals Comparison of Diagnostic Accuracy of PCR Targeting the 47-Kilodalton Protein Membrane Gene of Treponema pallidum and PCR Targeting the DNA Polymerase I Gene: Systematic Review and Meta-analysis

2015 ◽  
Vol 53 (11) ◽  
pp. 3522-3529 ◽  
Author(s):  
Angèle Gayet-Ageron ◽  
Christophe Combescure ◽  
Stephan Lautenschlager ◽  
Béatrice Ninet ◽  
Thomas V. Perneger
Keyword(s):  
Meta Analysis ◽  
Treponema Pallidum ◽  
Quality Criteria ◽  
Secondary Syphilis ◽  
Bibliographic Databases ◽  
Case Definitions ◽  
Content Type ◽  
Early Syphilis ◽  
Similar Accuracy ◽  
Pcr Targeting

Treponema pallidumPCR (Tp-PCR) testing now is recommended as a valid tool for the diagnosis of primary or secondary syphilis. The objectives were to systematically review and determine the optimal specific target gene to be used forTp-PCR. Comparisons of the performance of the two main targets aretpp47andpolAgenes were done using meta-analysis. Three electronic bibliographic databases, representing abstract books from five conferences specialized in infectious diseases from January 1990 to March 2015, were searched. Search keywords included (“syphilis” OR “Treponema pallidum” OR “neurosyphilis”) AND (“PCR” OR “PCR” OR “molecular amplification”). We included diagnostic studies assessing the performance ofTp-PCR targetingtpp47(tpp47-Tp-PCR) or thepolAgene (polA-Tp-PCR) in ulcers from early syphilis. All studies were assessed against quality criteria using the QUADAS-2 tool. Of 37 studies identified, 62.2% were judged at low risk of bias or applicability. Most used the U.S. Centers for Disease Control and Prevention (CDC) case definitions for primary or secondary (early) syphilis (89.2%;n= 33); 15 (40.5%) used darkfield microscopy (DFM). We did not find differences in sensitivity and specificity between the twoTp-PCR methods in the subgroup of studies using adequate reference tests. Among studies using DFM as the reference test, sensitivities were 79.8% (95% confidence intervals [CI], 72.7 to 85.4%) and 71.4% (46.0 to 88.0%) fortpp47-Tp-PCR andpolA-Tp-PCR (P= 0.217), respectively; respective specificities were 95.3% (93.5 to 96.6%) and 93.7% (91.8 to 95.2%) (P= 0.304). Our findings suggest that the twoTp-PCR methods have similar accuracy and could be used interchangeably.

Post-treatment serological changes in some patients with early syphilis exhibit a parabolic trend

2019 ◽  
Vol 30 (14) ◽  
pp. 1389-1396
Author(s):  
Yong Liu ◽  
Que-Qiao Bian ◽  
Shu-Huan Zhang ◽  
Jun Wang ◽  
Zhen-Ming Wang ◽  
...  
Keyword(s):  
Treatment Effectiveness ◽  
Treponema Pallidum ◽  
Secondary Syphilis ◽  
Post Treatment ◽  
Treatment Level ◽  
Early Syphilis ◽  
Primary Syphilis ◽  
Serum Titer ◽  
Pre Treatment ◽  
Latent Syphilis

Early syphilis accounts for a large proportion of patients with syphilis. Non- Treponema pallidum tests are commonly used to assess treatment effectiveness by analyzing the serological titer before treatment and six months after treatment. However, serological changes during the first three months after completion of treatment have not been completely understood. This prompted us to investigate whether serum titers of patients exhibit a continuous decrease post-treatment and to assess the trend of change in serological titer during this period. One hundred and seventy-three eligible patients with early syphilis were included in the analysis. Pre-treatment serological titers and those at three and six months post-treatment were compared and analyzed. Serological recovery was defined as a 4-fold or greater decrease in titer from pre-treatment level. Forty patients (23.1%) were found to have an increased serum titer at three months after treatment. Among the 40 patients, 13 patients had primary syphilis, 5 patients had secondary syphilis, and 22 patients had early latent syphilis. The proportion of patients with primary syphilis was higher, and their initial titers were significantly lower. No significant differences were observed with respect to age, gender, or initial treatment. The assessment results of 17 patients (9.8% of the total patients) change. Serological changes in some patients exhibit a parabolic pattern that may affect the clinician’s assessment of patient recovery. Therefore, more frequent assessment of serological titer might be required within the first six months post-treatment.

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