Folliculotropic non-alopecic secondary syphilis

Syphilitic Folliculitis: A Case Report With Demonstration of Spirochetes Showing Follicular Epitheliotropism

ABSTRACT

We report a case of a 59-year-old man presenting with a widespread follicular-based papular rash with a several-month history of myalgias, lymphadenopathy, fatigue, and weight loss who was diagnosed with acute syphilitic folliculitis by tissue biopsy analysis with immunohistochemical demonstration of spirochetes in hair follicle epithelium. Serologic analysis also showed evidence of Treponema sp. infection. Owing to the rising number of syphilis cases in the last decade, it is important to recognize classic cutaneous findings of syphilis in addition to unusual presentations such as syphilitic folliculitis.

Sexually acquired syphilis: Historical aspects, microbiology, epidemiology, and clinical manifestations

Syphilis is caused by infection with the spirochetal bacterium Treponema pallidum subsp. pallidum. It was first recognized in the late 15th century. Since 2000, the incidence of sexually acquired syphilis has increased substantially in the developed world, with men who have sex with men and persons living with HIV infection disproportionately affected. Clinical manifestations of syphilis are protean and often include mucocutaneous manifestations. The first article in this continuing medical education series reviews historical aspects, microbiology, epidemiology, and clinical manifestations of sexually acquired syphilis.

Secondary syphilis and HIV

Syphilis has been termed the "great mimic" due to its versatile and varied disease presentations. Dermatological findings are associated with the secondary phase of the disease and typically consist of a generalized papular eruption that can involve the palms and soles, genitals, and mucous membranes. Patients with syphilis and concomitant HIV infection may have altered presentations. We report a case of a 41-year-old HIV-positive man who presented with a papular rash of a few months' duration and was diagnosed with secondary syphilis.