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Schettini AP, Sardinha JC, Marques EA, Massone C. Psoriasiform syphilis: A challenge. Dermatol Reports 2021; 13:8830. [PMID: 35035804 PMCID: PMC8696190 DOI: 10.4081/dr.2021.8830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 07/11/2021] [Indexed: 11/23/2022] Open
Abstract
Syphilis is one of the greatest masqueraders in dermatology, like mycosis fungoides or sarcoidosis. In fact, secondary syphilis can simulate different dermatological conditions, not only clinically but also histopathologically. A 34-year-old Brazilian man from Manaus (Amazonas) attended our Department complaining for 2 weeks of asthenia, weight loss and multiple asymptomatic disseminated erythematous papules and scaly plaques with well-defined borders and a tendency to confluence were observed on the trunk, neck and extremities, clinically similar to psoriasis guttata. The skin biopsy and laboratory tests disclosed secondary syphilis and the patient was treated with intramuscular benzathine penicillin with prednisolone, with a complete resolution. Psoriasiform syphilis, which imitates psoriasis, was well known by old dermatologists and was called syphilide psoriasiforme or psoriasis syphilitique. Psoriasiform syphilis is one of the atypical presentations of secondary syphilis and dermatologists should be aware of psoriasiform syphilis in order not to improperly treat syphilis patients with immunosuppressive drugs; also, pathologists should be aware of secondary syphilis histopathological features.
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Gonzalez Collazo MP, Rebollo Rodriguez NP, Santiago-Vazquez M, Crespo-Ramos SM, Marcos-Martinez MJ, Villegas VM, Oliver AL. Bilateral hypopyon in syphilitic uveitis. Am J Ophthalmol Case Rep 2021; 21:101007. [PMID: 33437894 PMCID: PMC7788489 DOI: 10.1016/j.ajoc.2020.101007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/25/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To report an atypical bilateral hypopyon presentation of syphilitic uveitis. OBSERVATIONS A 38-year-old male presented with a 2-day history of bilateral progressive visual loss, conjunctival hyperemia, and photophobia. Initial ophthalmologic examination revealed bilateral hypopyon and vitritis that limited the examination of the posterior segment. The physical exam revealed cervical lymphadenopathy, glossal leukoplakia, erythematous maculae on the hard palate, erythematous macular lesions on both palms, onychodystrophy, onycholysis, and psoriasiform plaques on both plantar surfaces, testicular tenderness, and hypopigmented patches on the scrotal and perianal skin. A therapeutic and diagnostic vitrectomy was performed on the right eye, and the intraoperative findings were consistent with severe vitritis and pre-retinal precipitates. The cytopathologic analysis of the right vitreous revealed a mixed inflammatory process composed of lymphocytes, histiocytes, and neutrophils in a proteinaceous background. Laboratory testing revealed positive serum RPR, CSF FTA-Abs and VDRL, and HIV serology. Treatment with a 2-week course of intravenous penicillin G 4 million units every 4 hours and topical corticosteroids resulted in complete resolution of the uveitis. CONCLUSIONS AND IMPORTANCE Bilateral hypopyon uveitis may be a rare presentation of syphilitic uveitis. As with most forms of uveitis, syphilis should be considered in the differential diagnosis of patients presenting with bilateral hypopyon.
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Affiliation(s)
- Monica P. Gonzalez Collazo
- University of Puerto Rico, Medical Sciences Campus, School of Medicine, Department of Ophthalmology, San Juan, PR, USA
| | - Nicole P. Rebollo Rodriguez
- University of Puerto Rico, Medical Sciences Campus, School of Medicine, Department of Ophthalmology, San Juan, PR, USA
| | - Marely Santiago-Vazquez
- University of Puerto Rico, Medical Sciences Campus, School of Medicine, Department of Dermatology, San Juan, PR, USA
| | - Susanne M. Crespo-Ramos
- University of Puerto Rico, Medical Sciences Campus, School of Medicine, Department of Pathology and Laboratory Medicine, San Juan, PR, USA
- Puerto Rico Medical Services Administration Pathology Laboratory, San Juan, PR, USA
| | - Maria J. Marcos-Martinez
- University of Puerto Rico, Medical Sciences Campus, School of Medicine, Department of Pathology and Laboratory Medicine, San Juan, PR, USA
- Puerto Rico Medical Services Administration Pathology Laboratory, San Juan, PR, USA
| | - Víctor M. Villegas
- University of Puerto Rico, Medical Sciences Campus, School of Medicine, Department of Ophthalmology, San Juan, PR, USA
| | - Armando L. Oliver
- University of Puerto Rico, Medical Sciences Campus, School of Medicine, Department of Ophthalmology, San Juan, PR, USA
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