A 42-year-old man with nodular skin lesions

2021 ◽  
Vol 6 (2) ◽  
pp. 168-172
Author(s):  
Majid Darraj ◽  
Andrew Walkty ◽  
John Toole ◽  
Thomas Marrie ◽  
Leah Huzel ◽  
...  
Keyword(s):  
Skin Lesions ◽  
Punch Biopsy ◽  
Secondary Syphilis ◽  
Penicillin G ◽  
Silver Stain ◽  
Current Increase ◽  
Cutaneous Eruption ◽  
Benzathine Penicillin G ◽  
Timely Fashion ◽  
Dermatologic Manifestations

Nodular skin lesions are infrequently reported among patients with syphilis. We describe a 42-year-old man with secondary syphilis who presented with a nodular cutaneous eruption involving his neck, upper chest, back, arms, and legs. Because there was uncertainty regarding the diagnosis at presentation, the patient underwent a punch biopsy of one of the lesions. Spirochetes were not seen with a Steiner silver stain, but they were visualized on subsequent immunohistochemical staining. The diagnosis was confirmed with serology, and the patient responded well to treatment with benzathine penicillin G. Given the current increase in syphilis cases across North America, it is critical that clinicians become familiar with some of the less common dermatologic manifestations of this infection so that the diagnosis is entertained and appropriate serologic testing is ordered in a timely fashion.

scholarly journals Psoriasiform Secondary Syphilis: A Pitfall in Diagnosis

2021 ◽  
Vol 7 (1) ◽  
pp. 1-3
Author(s):  
Satiti Retno Pudjiati ◽  
Keyword(s):  
High Titer ◽  
Seborrheic Dermatitis ◽  
Immune Deficiency Syndrome ◽  
Skin Lesions ◽  
Deficiency Syndrome ◽  
Secondary Syphilis ◽  
Penicillin G ◽  
Serological Examination ◽  
Benzathine Penicillin G ◽  
The Face

Secondary syphilis in Acquired Immune Deficiency Syndrome (AIDS) patient’s have variety of skin manifestations. Failure to recognize the manifestations of secondary syphilis can cause delaying the therapy. The recognition of the characteristics of skin lesions as well as serology examination and histopathology help the physicians for making the diagnosis. A 24-year-old male who was diagnosed with HIV previously came with chief complaint of scaly red plaques on the palms and soles. The similar lesions were also notedover the face especially the perioral region.Patient also noted to have also alopecia on the eyebrows and eyelashes. Patient was diagnosed with psoriasis vulgaris from previous physician and treated with unknown therapy. Serological examination revealed reactive TPHA and high titer of VDRL. Skin biopsy was done and it has features of psoriasis but without pathognomonic signs. The patient then was treated with single dose of benzathine penicillin G 2,4 million units which provided excellent improvement.Secondary syphilis is called "great imitator" because of its broad manifestations. It has been widely reported that secondary syphilis has been misdiagnosed as psoriasis and seborrheic dermatitis. Characteristics of the lesion, serological examination and histopathology play significant role in establishing the diagnosis.

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 Diffuse Hair Loss in Secondary Syphilis in HIV Positive Man: Case Report

2012 ◽  
Vol 29 (4) ◽  
pp. 193-197 ◽  
Author(s):  
Milan Bjekić
Keyword(s):  
Hair Loss ◽  
Scalp Hair ◽  
Secondary Syphilis ◽  
Penicillin G ◽  
Hiv Positive ◽  
Oral Lesions ◽  
Benzathine Penicillin ◽  
Serological Tests ◽  
Benzathine Penicillin G ◽  
Macular Rash

SUMMARY Hair loss is not a common feature of secondary syphilis. There are two types of syphilitic alopecia: “symptomatic” type where hair loss is associated with other symptoms of secondary syphilis, and “essential” alopecia that is either patchy (“moth-eaten” type), diffuse pattern with a generalized thinning of the scalp hair, or a combination of both without any other mucocutaneous signs of syphilis. This article presents a case of syphilitic alopecia in a 30-year-old homosexual man. The patient had diffuse non-scarring alopecia of his scalp and loss of eyelashes and eyebrows. A macular rash with palmar-plantar involvement and oral lesions coexisted with the hair loss. Serological tests for syphilis were positive. The patient was treated with a single dose of benzathine penicillin G, 2.4 million units intramuscularly. Within three months there was dramatic hair regrowth, and all syphilitic lesions resolved. Patient was councelled and tested on HIV. The HIV seropositivity was confirmed by Western blot analysis. Syphilitic alopecia should not be overlooked in patients with non-scarring hair loss. Serologic testing for syphilis is recommended in patients with unexplained rapid hair loss. However, all patients presenting with syphilis should be offered HIV testing.

Relapse of Secondary Syphilis After Benzathine Penicillin G

2004 ◽  
Vol 31 (3) ◽  
pp. 196-199 ◽  
Author(s):  
Michael Myint ◽  
Houman Bashiri ◽  
Robert D. Harrington ◽  
Christina M. Marra
Keyword(s):  
Secondary Syphilis ◽  
Penicillin G ◽  
Benzathine Penicillin ◽  
Benzathine Penicillin G

scholarly journals Malignant syphilis as the first manifestation of HIV infection

2012 ◽  
Vol 4 (1) ◽  
pp. 15 ◽  
Author(s):  
Efstathios Rallis ◽  
Vasileios Paparizos
Keyword(s):  
Hiv Infection ◽  
Clinical Manifestation ◽  
Skin Lesions ◽  
Secondary Syphilis ◽  
Penicillin G ◽  
Homosexual Male ◽  
Ulcerative Lesions ◽  
Thick Crust

Malignant syphilis is a rare and severe variant of secondary syphilis. It is clinically characterized by large papular, nodular and ulcerative lesions affecting the trunk and the extremities and covered with thick crust. We present a case of 52-year-old homosexual male who developed malignant syphilis and this was the first clinical manifestation of HIV infection. The patient was treated successfully with intravenous aqueous crystalline penicillin G. Physicians should recognize malignant syphilis and considered it in all HIV-infected individuals with ulceronodular skin lesions.

scholarly journals Benzathine Penicillin G in the Control of Gonorrhoea

1957 ◽  
Vol 33 (1) ◽  
pp. 40-42
Author(s):  
C. E. Hookings ◽  
L. M. Graves
Keyword(s):  
Penicillin G ◽  
Benzathine Penicillin ◽  
Benzathine Penicillin G

Three-Versus Four-week Administration of Benzathine Penicillin G: Effects on Incidence of Streptococcal Infections and Recurrences of Rheumatic Fever

PEDIATRICS ◽  
1996 ◽  
Vol 97 (6) ◽  
pp. 984-988
Author(s):  
Hung-Chi Lue ◽  
Mei-Hwan Wu ◽  
Jou-Kou Wang ◽  
Fen-Fen Wu ◽  
Yu-Nian Wu
Keyword(s):  
Rheumatic Fever ◽  
Color Doppler ◽  
Clinic Visit ◽  
Penicillin G ◽  
Controlled Study ◽  
Streptococcal Infections ◽  
Benzathine Penicillin ◽  
Acute Phase Reactants ◽  
Weight Percentage ◽  
Benzathine Penicillin G

Objective. To investigate the effects of 3-week versus 4-week administration of benzathine penicillin G (BPG) on the incidence of Group A streptococcal infections and the recurrences of rheumatic fever (RF). Study Design. We started, in 1979, randomly allocating all patients with RF to a 3-week or 4-week BPG prophylaxis program. They were examined at the RF clinic, every 3 to 6 months, and at any time they did not feel well. During 1979 to 1989, throat cultures and sera for antistreptolysin O and streptozyme titers were obtained at each clinic visit. Chest radiographs, electrocardiogram, color Doppler echocardiograms, and acute phase reactants were obtained. Subjects. Two hundred forty-nine patients fulfilled the revised Jones criteria and were followed until December 1991: 124 in the 3-week and 125 in the 4-week program. Their age, sex, weight, percentage with history of RF, severity of cardiac involvement, follow-up duration, and compliance to program were comparable. Eight hundred eighty throat cultures were collected in the 3-week program and 770 were collected in the 4-week program. Six hundred sixteen and 627 sera were determined in each program for antistreptolysin O, and 582 and 592 sera for streptozyme titers. Results. True streptococcal infections occurred in both programs: 39 infections in the 3-week program, and 59 infections in the 4-week program (7.5 vs 12.7 per 100 patient-years). Four infections with no antibody response occurred in the 3-week program, and three such infections in the 4-week program. Nine RF recurrences occurred in 8 patients in the 3-week program, and 16 recurrences in 16 patients in the 4-week program. Prophylaxis failure occurred in 2 of 124 patients in the 3-week program, and in 10 of 125 patients in the 4-week program (0.25 vs 1.29 per 100 patient-years). The overall recurrences/infections rate in each program was comparable, 13.6% vs 15.5%, but the recurrences/infections rate due to prophylaxis failure was higher in the 4-week program than in the 3-week program, 3.0% versus 9.7%. Conclusions. This 12-year prospective and controlled study documented that streptococcal infections and RF recurrences occurred more often in the 4-week program than in the 3-week program. The risk of prophylaxis failure was fivefold greater in the 4-week program than in the 3-week program.

scholarly journals A Case of Rupioid Syphilis Masquerading as Aggressive Cutaneous Lymphoma

2015 ◽  
Vol 7 ◽  
pp. e2015026 ◽  
Author(s):  
Jonathan Braue ◽  
Thomas Hagele ◽  
Abraham Tareq Yacoub ◽  
Suganya Mannivanan ◽  
Frank Glass ◽  
...  
Keyword(s):  
19Th Century ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
Rare Case ◽  
Skin Lesions ◽  
Secondary Syphilis ◽  
Cutaneous Lymphoma ◽  
Hiv Positive ◽  
Late 19Th Century ◽  
Inflammatory Syndrome

Secondary syphilis has been known since the late 19th century as the great imitator; however, some experts now regard cutaneous lymphoma as the great imitator of skin disease. Either disease, at times an equally fastidious diagnosis, has reported to even mimic each other. It is thus vital to consider these possibilities when presented with a patient demonstrating peculiar skin lesions. No other manifestation of secondary syphilis may pose such quandary as a rare case of rupioid syphilis impersonating cutaneous lymphoma. We present such a case, of a 36-year-old HIV positive male, misdiagnosed with aggressive cutaneous lymphoma, actually exhibiting rupioid syphilis thought secondary to immune reconstitution inflammatory syndrome (IRIS).

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