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Dimnik J, Benko M, Hosta V, Murnik Rauh A, Pagon A, Špik VC, Battelino S, Vozel D. Malignant Syphilis in a Female Patient: A Case Report and Mini-Review. Trop Med Infect Dis 2022; 7:tropicalmed7030047. [PMID: 35324594 PMCID: PMC8950934 DOI: 10.3390/tropicalmed7030047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/03/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022] Open
Abstract
Malignant syphilis (MS) is a rare form of secondary syphilis with grotesque skin lesions, systemic manifestation and life-threatening complications. This article presents a case of MS in an immunocompetent 41-year-old female, who initially manifested with a generalized nonpruritic erythematous rash and systemic symptoms. She was mistreated for generalized impetigo and hepatitis attributed to chronic alcoholism. After partial recovery and a 3-month latent period, she developed infiltrated plaques with crusts on the trunk, head and neck; pharyngitis and laryngeal lesions; generalized lymphadenopathy and nonspecific systemic symptoms. Serologic tests confirmed syphilis, and cerebrospinal fluid analyses indicated the presence of anti-treponemal antibodies. Urine drug screening was positive for cannabinoids. The polymerase chain reaction from skin biopsy samples identified T. pallidum, confirmed with Warthin-Starry staining. Immunohistochemical analysis was uncharacteristic. Tertiary syphilis, neurosyphilis, ocular syphilis and otosyphilis were excluded. However, the patient was treated for neurosyphilis with benzylpenicillin (18 million IU intravenously daily, 14 days) and corticosteroids. No Jarisch-Herxheimer reaction occurred. Ten months after treatment, residual scars were visible, and 1 year later, she attempted suicide. Since MS can resemble other diseases, it should be suspected in a mentally ill patient with chronic drug abuse, systemic nonspecific manifestations and dermatological abnormalities, including the head and neck region.
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Affiliation(s)
- Julija Dimnik
- Department of Dermatovenereology, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia; (J.D.); (M.B.); (V.H.); (A.M.R.); (A.P.)
| | - Maja Benko
- Department of Dermatovenereology, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia; (J.D.); (M.B.); (V.H.); (A.M.R.); (A.P.)
| | - Violeta Hosta
- Department of Dermatovenereology, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia; (J.D.); (M.B.); (V.H.); (A.M.R.); (A.P.)
| | - Andreja Murnik Rauh
- Department of Dermatovenereology, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia; (J.D.); (M.B.); (V.H.); (A.M.R.); (A.P.)
| | - Andreja Pagon
- Department of Dermatovenereology, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia; (J.D.); (M.B.); (V.H.); (A.M.R.); (A.P.)
| | - Vesna Cvitković Špik
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Ljubljana, SI-1000 Ljubljana, Slovenia;
| | - Saba Battelino
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia;
- Faculty of Medicine, University of Ljubljana, SI-1000 Ljubljana, Slovenia
| | - Domen Vozel
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, SI-1000 Ljubljana, Slovenia;
- Faculty of Medicine, University of Ljubljana, SI-1000 Ljubljana, Slovenia
- Correspondence:
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Fustà-Novell X, Morgado-Carrasco D, Barreiro-Capurro A, Manzardo C, Alsina-Gibert M, Fuertes-de Vega I, Blanco JL, González A, Moreno A, Álvarez M, Bosch J. Syphilis Maligna: A Presentation to Bear in Mind. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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3
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Fustà-Novell X, Morgado-Carrasco D, Barreiro-Capurro A, Manzardo C, Alsina-Gibert M. Syphilis Maligna: A Presentation to Bear in Mind. ACTAS DERMO-SIFILIOGRAFICAS 2018; 110:232-237. [PMID: 30098705 DOI: 10.1016/j.ad.2018.02.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 01/30/2018] [Accepted: 02/04/2018] [Indexed: 11/26/2022] Open
Abstract
Malignant syphilis is an uncommon form of secondary syphilis associated with HIV infection. Clinically, it is characterized by necrotic nodules and generalized ulcerated lesions. We present 4 cases of malignant syphilis diagnosed after evaluating syphilis cases diagnosed at our hospital between 2012 and 2016. We describe the epidemiologic, clinical, histiopathologic, and serologic characteristics of malignant syphilis and explore its response to treatment and association with HIV infection. Although malignant syphilis is uncommon, there has been an increase in the number of cases published in recent years, particularly in young HIV-positive patients. Malignant syphilis must be contemplated in the differential diagnosis of HIV patients with ulcerated, necrotic lesions.
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Affiliation(s)
- X Fustà-Novell
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - A Barreiro-Capurro
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - C Manzardo
- Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - M Alsina-Gibert
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España.
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- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España; Servicio de Microbiología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
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Barros D'Elia Zanella L, Facchini Lellis R, Khoury Z, Keiko Matsuka Oyafuso L, Figueiredo-Mello C. Rupioid lesions, PLEVA and superposition phenomenon in malignant syphilis: two case reports in HIV-infected patients. J Eur Acad Dermatol Venereol 2017; 32:e91-e92. [DOI: 10.1111/jdv.14563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
| | - R. Facchini Lellis
- Emilio Ribas Infectious Diseases Institute (IIER); São Paulo Brazil
- Medical School of Santa Casa; São Paulo Brazil
| | - Z. Khoury
- Emilio Ribas Infectious Diseases Institute (IIER); São Paulo Brazil
| | - L. Keiko Matsuka Oyafuso
- Emilio Ribas Infectious Diseases Institute (IIER); São Paulo Brazil
- Medical School of ABC; São Paulo Brazil
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Ivars Lleó M, Clavo Escribano P, Menéndez Prieto B. Atypical Cutaneous Manifestations in Syphilis. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Ivars Lleó M, Clavo Escribano P, Menéndez Prieto B. Atypical Cutaneous Manifestations in Syphilis. ACTAS DERMO-SIFILIOGRAFICAS 2015; 107:275-83. [PMID: 26708562 DOI: 10.1016/j.ad.2015.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 10/26/2015] [Accepted: 11/07/2015] [Indexed: 11/16/2022] Open
Abstract
Although the diversity of the clinical manifestations of syphilis is well-known, atypical presentations can also occur. Such atypical presentations are associated with a high risk of transmission as a result of diagnostic confusion and treatment delays owing to the disease's ability to mimic other common skin diseases, deviate from classic clinical presentations, and adopt unique forms. Cases of atypical syphilis have been described most frequently in patients with concomitant human immunodeficiency virus (HIV) infection. Because the incidence of syphilis has been growing over recent years -particularly in patients with HIV co-infection- dermatologists need to be familiar with the less well-known clinical presentations of this venereal disease.
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Affiliation(s)
- M Ivars Lleó
- Departamento de Dermatología, Clínica Universidad de Navarra, Pamplona, España.
| | - P Clavo Escribano
- Departamento de Dermatología, Centro Sanitario Sandoval, Madrid, España
| | - B Menéndez Prieto
- Departamento de Microbiología, Centro Sanitario Sandoval, Madrid, España
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Abstract
Malignant syphilis is an uncommon, but not unknown, ulcerative variation of secondary syphilis. The lesions typically begin as papules, which quickly evolve to pustules and then to ulcers with elevated edges and central necrosis. It is usually, but not mandatory, found in patients with some level of immunosuppression, such as HIV patients, when the TCD4(+) cell count is >200 cells/mm(3). Despite the anxiety the lesions cause, this form of the disease has a good prognosis. The general symptoms disappear right after the beginning of treatment, and lesions disappear over a variable period. This study reports the case of a 27-year-old man who has been HIV positive for 6 years, uses antiretroviral therapy incorrectly, has a TCD4(+) cell count of 340 cells/mm(3), a VDRL of 1:128 and itchy disseminated hyperchromic maculopapular lesions with rupioid crusts compatible with malignant syphilis.
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García-Martínez F, Fernández-Redondo V, Sánchez-Aguilar D, Toribio J. Sífilis maligna en un paciente inmunocompetente. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:437-9. [DOI: 10.1016/j.ad.2011.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 05/19/2011] [Accepted: 06/06/2011] [Indexed: 11/25/2022] Open
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García-Martínez F, Fernández-Redondo V, Sánchez-Aguilar D, Toribio J. Malignant Syphilis in an Immunocompetent Patient. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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10
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Sammet S, Niedermeier A, Bogner J, Mackert M, Gauglitz G, Ruzicka T. Die ungewöhnlichen Gesichter der Syphilis. Hautarzt 2011; 63:415-22. [DOI: 10.1007/s00105-011-2249-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity. Am J Dermatopathol 2011; 33:433-60. [PMID: 21694502 DOI: 10.1097/dad.0b013e3181e8b587] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Syphilis has plagued mankind for centuries and is currently resurgent in the Western hemisphere. Although there has been a significant reduction of tertiary disease and recognition of facilitative interactions with human immunodeficiency virus infection, the natural history of syphilis has remained largely unchanged; thus, new strategies are required to more effectively combat this pathogen. The immunopathologic features of experimental syphilis in the rabbit; the course, stages, and pathology of human syphilis; and a comparison of human syphilis with leprosy suggest that the clinical course of syphilis and its tissue manifestations are determined by the balance between delayed-type hypersensitivity (DTH) and humoral immunity to the causative agent, Treponema pallidum. A strong DTH response is associated with clearance of the infecting organisms in a well-developed chancre, whereas a cytotoxic T-cell response or strong humoral antibody response is associated with prolonged infection and progression to tertiary disease. Many of the protean symptoms/appearances of secondary and tertiary human syphilis are manifestations of immune reactions that fail to clear the organism, due to a lack of recruitment and, more importantly, activation of macrophages by sensitized CD4 T cells. The Bacillus Calmette-Guerin vaccination can enhance DTH and has been shown to produce a low, but measurable, beneficial effect in the prevention of leprosy, a disease that shows a disease spectrum with characteristics in common with syphilis. In the prevention of syphilis, a potential vaccine protective against syphilis should be designed to augment the DTH response.
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Pérez-Pelegay J, Sánchez-Salas M, Ventura-Faci P, Grasa-Jordán M, Carapeto F. The Past, Present, and Future of Pemphigus Syphiliticus. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s1578-2190(08)70340-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Pérez-Pérez L, Cabanillas M, Ginarte M, Sánchez-Aguilar D, Toribio J. Sífilis maligna en un paciente con infección por el VIH. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s0001-7310(07)70080-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Malignant Syphilis in an HIV-Infected Patient. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s1578-2190(07)70460-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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