Secondary syphilis: The great imitator can't be forgotten

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.

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

International Journal of STD & AIDS ◽

10.1177/0956462417733351 ◽

2017 ◽

Vol 29 (4) ◽

pp. 410-413 ◽

Cited By ~ 3

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.

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

International Journal of STD & AIDS ◽

10.1177/0956462418795590 ◽

2018 ◽

Vol 29 (14) ◽

pp. 1454-1456 ◽

Cited By ~ 4

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.

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

International Journal of STD & AIDS ◽

10.1177/0956462417726203 ◽

2017 ◽

Vol 29 (1) ◽

pp. 99-102 ◽

Cited By ~ 2

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.

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

Case Reports in Medicine ◽

10.1155/2017/2481961 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Sunit Tolia ◽

Hassan Kassem ◽

Ana Capatina-Rata

Keyword(s):

Human Immunodeficiency Virus ◽

Primary Care Physicians ◽

Treponema Pallidum ◽

Disease Process ◽

The United States ◽

Secondary Syphilis ◽

Cutaneous Manifestations ◽

Hiv Coinfection ◽

Immunodeficiency Virus ◽

Alkaline Phosphate

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

SKIN The Journal of Cutaneous Medicine ◽

10.25251/skin.4.4.15 ◽

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.

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Penile annular secondary syphilis mimicking annular lichen planus

International Journal of Dermatology ◽

10.1111/ijd.15703 ◽

2021 ◽

Author(s):

Ngo Binh Trinh ◽

Yu‐Hung Wu ◽

Hoang Trung Hieu

Keyword(s):

Lichen Planus ◽

Secondary Syphilis

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Sweet Syndrome and Secondary Syphilis in a Person with Acute Necrotizing Tonsillitis

Case Reports in Dermatology ◽

10.1159/000509374 ◽

2021 ◽

Vol 13 (1) ◽

pp. 216-221

Author(s):

Joseph Mishal ◽

Igor Viner ◽

Alexandro Livoff ◽

Shlomo Maayan ◽

Eli Magen

Keyword(s):

Unusual Case ◽

Treponema Pallidum ◽

Cervical Lymphadenopathy ◽

Secondary Syphilis ◽

Neutrophilic Dermatosis ◽

Sweet Syndrome ◽

Acute Febrile Neutrophilic Dermatosis ◽

Acute Necrotizing ◽

The Right ◽

Syphilis Serology

Syphilis has received its classical designation as one of “the great imitators,” reflecting a wide variety of symptoms and presentations, which can cause difficulties in diagnosis. Here we report an unusual case of secondary syphilis in a person with acute necrotizing tonsillitis and Sweet syndrome. A 33-year-old female presented with fever, bilateral cervical lymphadenopathy, tonsillar enlargements with ulcerated pus-filled lesions on the right tonsil, and multiple pseudovesicular, mammillated, edematous plaques on her neck, face, and extremities. Syphilis serology was positive and a skin biopsy demonstrated a neutrophil-rich dermatitis characteristic of Sweet syndrome. The association of <i>Treponema pallidum</i> infection with Sweet syndrome may be a coincidence; nevertheless, our case serves as a reminder that secondary syphilis should remain in the differential diagnosis of the acute febrile neutrophilic dermatosis.

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Using Joinpoint Regression for the Analysis of Trends in Syphilis Incidence in Poland in the Years 1950–2017

Studies in Logic, Grammar and Rhetoric ◽

10.2478/slgr-2019-0041 ◽

2019 ◽

Vol 60 (1) ◽

pp. 7-18

Author(s):

Marcin Milewski ◽

Rafał Milewski ◽

Gabriela Sokołowska ◽

Anna Justyna Milewska

Keyword(s):

Transmitted Disease ◽

Treponema Pallidum ◽

Epidemiological Studies ◽

Sexual Contact ◽

Regression Method ◽

Serological Response ◽

Joinpoint Regression ◽

Sexually Transmitted ◽

The Impact ◽

Splitting Time

Abstract Syphilis is a bacterial sexually transmitted disease (STD), whose main route of infection is through sexual contact. In order to diagnose syphilis, Treponema pallidum must be detected in the material sampled from a lesion and a blood test must be performed in order to detect serological response to syphilis. Since 1946, a statutory obligation to report all cases of syphilis has been in force in Poland, which is why data concerning the incidence is available. The aim of this paper is to analyse trends in syphilis incidence in the years 1950–2017 using Joinpoint Regression and to present the impact of prophylaxis and education of society on syphilis prevention. The Joinpoint Regression method indicated the splitting time points of the trend corresponding to real changes in incidence, which corroborates the purpose of using the method in question in epidemiological studies.

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