1
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Malamos D. A peculiar "diamond ring" like lesion in the palate of a young anorexic homosexual man. Oral Dis 2024; 30:825-827. [PMID: 36705484 DOI: 10.1111/odi.14522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/20/2022] [Accepted: 01/24/2023] [Indexed: 01/28/2023]
Affiliation(s)
- Dimitris Malamos
- Oral Medicine Clinic for the Provision of Health System, Athens, Greece
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2
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Ciccarese G, Facciorusso A, Mastrolonardo M, Herzum A, Parodi A, Drago F. Atypical Manifestations of Syphilis: A 10-Year Retrospective Study. J Clin Med 2024; 13:1603. [PMID: 38541829 PMCID: PMC10971508 DOI: 10.3390/jcm13061603] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/24/2024] [Accepted: 02/28/2024] [Indexed: 07/24/2024] Open
Abstract
Background: The incidence of syphilis has increased in high-income countries in the past few decades, especially among men who have sex with men. In the present study, we aimed to analyze the correlations between atypical syphilis manifestations and the demographic, clinical, and laboratory features of patients and to review unusual presentations of syphilis reported in the literature. Methods: We conducted a retrospective analysis of 307 patients with syphilis diagnosed between 1 January 2013 and 31 October 2023 at the sexually transmitted infection (STI) centers of the University of Genoa and University of Foggia with both typical and atypical manifestations of disease. Results: In our series, atypical manifestations were detected in 25.8% of the patients, especially in the secondary stage of the disease. Lesions with annular morphology and lesions presenting as itchy erythematous scaly plaques with a psoriasiform appearance were the most common atypical presentations of secondary syphilis. A statistical analysis revealed that homosexual orientation, syphilis reinfection, and venereal disease research laboratory (VDRL) titers > 1:32 were correlated with atypical manifestations. Conclusions: Our study demonstrates that the spectrum of syphilis manifestations, in all the stages of the disease, is wide; atypical manifestations often pose diagnostic challenges, may delay the provision of appropriate treatment, and facilitate the spread of the infection.
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Affiliation(s)
- Giulia Ciccarese
- Section of Dermatology, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy; (G.C.); (M.M.)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, 00161 Foggia, Italy;
| | - Mario Mastrolonardo
- Section of Dermatology, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy; (G.C.); (M.M.)
| | - Astrid Herzum
- Dermatology Unit, IRCCS Giannina Gaslini, 16147 Genova, Italy
| | - Aurora Parodi
- Section of Dermatology, Department of Health Sciences, University of Genoa, IRCCS—Ospedale Policlinico San Martino, 16132 Genoa, Italy; (A.P.); (F.D.)
| | - Francesco Drago
- Section of Dermatology, Department of Health Sciences, University of Genoa, IRCCS—Ospedale Policlinico San Martino, 16132 Genoa, Italy; (A.P.); (F.D.)
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3
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Montenegro-Idrogo JJ, Muñante R, López-Fuentes M, Sanz-Castro M, Ventura-León A, Chávez-Esparza G, García-Cortez Y. Malignant syphilis as the presenting complaint of advanced HIV. Int J STD AIDS 2023:9564624231162415. [PMID: 36920282 DOI: 10.1177/09564624231162415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Malignant syphilis is an infrequent secondary manifestation in patients with human immunodeficiency virus (HIV), with polymorphous and disseminated skin lesions being related to severe immunosuppression. Lesions have intense inflammatory circinate, ulcer-crusted and nodular skin lesions of diffuse distribution throughout the body, that can be confused with vasculitis or cutaneous lymphomas. We report a patient recently diagnosed with HIV infection in the acquired immunodeficiency syndrome stage with malignant syphilis as the debut of HIV.
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Affiliation(s)
- Juan José Montenegro-Idrogo
- 471931Facultad de Ciencias de La Salud Universidad Científica Del Sur, Lima, Perú.,Servicio de Medicina de Enfermedades Infecciosas y Tropicales, 504674Hospital Nacional Dos de Mayo, Lima, Perú
| | - Ricardo Muñante
- Servicio de Medicina de Enfermedades Infecciosas y Tropicales, 504674Hospital Nacional Dos de Mayo, Lima, Perú
| | - Manuel López-Fuentes
- Servicio de Anatomía Patológica, 504674Hospital Nacional Dos de Mayo, Lima, Perú
| | | | | | - Gonzalo Chávez-Esparza
- Servicio de Medicina de Enfermedades Infecciosas y Tropicales, 504674Hospital Nacional Dos de Mayo, Lima, Perú
| | - Yuri García-Cortez
- Servicio de Medicina de Enfermedades Infecciosas y Tropicales, 504674Hospital Nacional Dos de Mayo, Lima, Perú
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4
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Kim MG, Kamath V, Martinello M, Overton K. Case report of a man with HIV presenting with malignant syphilis. Sex Health 2023; 20:83-86. [PMID: 36508716 DOI: 10.1071/sh22161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Malignant syphilis is a rare manifestation of secondary syphilis and is commonly associated with human immunodeficiency virus coinfection. It can present with multiorgan involvement, which poses a diagnostic dilemma to clinicians. METHODS We report a case of a middle aged male who presented with near complete vision loss in his right eye with initial concern for fungal endophthalmitis due to his injecting drug use history. He concurrently had right cheek and forearm ulcerative plaques. RESULTS He was diagnosed with disseminated syphilis following the punch biopsy of his right cheek, with positive Treponema pallidum result on polymerase chain reaction and identification of spirochaetes on immunostaining from histopathology. CONCLUSIONS We present the epidemiology of syphilis in Australia and highlight the importance of testing for common sexually transmitted diseases within the emergence of the monkeypox outbreak.
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Affiliation(s)
- Myong Gyu Kim
- School of Clinical Medicine, UNSW Sydney, Kensington, Sydney, NSW, Australia; and Department of Infectious Diseases, Prince of Wales Hospital, Randwick, Sydney, NSW, Australia
| | - Vasanth Kamath
- School of Clinical Medicine, UNSW Sydney, Kensington, Sydney, NSW, Australia; and Department of Anatomical Pathology, Prince of Wales Hospital, Randwick, Sydney, NSW, Australia
| | - Marianne Martinello
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, Sydney, NSW, Australia; and Kirby Institute, UNSW Sydney, Kensington, NSW, Australia
| | - Kristen Overton
- School of Clinical Medicine, UNSW Sydney, Kensington, Sydney, NSW, Australia; and Department of Infectious Diseases, Prince of Wales Hospital, Randwick, Sydney, NSW, Australia
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5
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Whiting C, Schwartzman G, Khachemoune A. Syphilis in Dermatology: Recognition and Management. Am J Clin Dermatol 2023; 24:287-297. [PMID: 36689103 PMCID: PMC9869822 DOI: 10.1007/s40257-022-00755-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 01/24/2023]
Abstract
The incidence of syphilis has been increasing in the USA since 2000. Notably, the coronavirus disease 2019 pandemic negatively impacted the public health efforts to contain the spread of sexually transmitted diseases including syphilis and congenital syphilis. Clinical manifestations of syphilis are predominantly mucocutaneous lesions, thus dermatologists are primed to recognize the myriad presentations of this disease. Primary syphilis is classically characterized by a painless transient chancre most often located in the genital area. Secondary syphilis typically manifests clinically as systemic symptoms in addition to a mucocutaneous eruption of which a variety of forms exist. Although less common in the era of effective penicillin treatment, late clinical manifestations of syphilis are described as well. In addition to recognition of syphilis on physical examination, several diagnostic tools may be used to confirm infection. Treponema pallidum spirochetes may be detected directly using histopathologic staining, darkfield microscopy, direct fluorescent antibody, and polymerase chain reaction assays. A table detailing the histopathologic features of syphilis is included in this article. Serologic testing, non-treponemal and treponemal tests, is the preferred method for screening and diagnosing syphilis infections. Two serologic testing algorithms exist to aid clinicians in diagnosing positive syphilis infection. Determining the correct stage of syphilis infection combines results of serologic tests, patient history, and physical examination findings. Using the current Centers for Disease Control and Prevention case definitions and treatment guidelines, a management algorithm is proposed here. Penicillin remains the pharmacological treatment of choice although specific clinical situations allow for alternative therapies. Syphilis is a reportable disease in every state and should be reported by stage according to individual state requirements. Screening recommendations are largely based upon risks encountered through sexual exposures. Likewise, sexual partner management includes evaluating and treating persons exposed to someone diagnosed with an infective stage of syphilis. Close clinical follow-up and repeat testing are recommended to ensure appropriate response to treatment. This guide will discuss the current epidemiology of syphilis and focus on practice aspects of diagnosis and management, including public health reporting.
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Affiliation(s)
- Cleo Whiting
- grid.253615.60000 0004 1936 9510School of Medicine and Health Sciences, George Washington University, Washington, DC USA
| | - Gabrielle Schwartzman
- grid.253615.60000 0004 1936 9510School of Medicine and Health Sciences, George Washington University, Washington, DC USA
| | - Amor Khachemoune
- Department of Dermatology, Veterans Affairs Medical Center, State University of New York Downstate, 800 Poly Place, Brooklyn, NY, 11209, USA. .,Department of Dermatology, Veterans Health Administration, Brooklyn, NY, USA.
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6
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Wibisono O, Idrus I, Djawad K. Malignant Syphilis: A Systematic Review of the Case Reports Published in 2014-2018. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S1578-2190(21)00174-8. [PMID: 34052138 DOI: 10.1016/j.adengl.2021.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/13/2021] [Indexed: 01/06/2023] Open
Abstract
Malignant syphilis (MS) is a rare manifestation of secondary syphilis which mainly occurs in immunocompromised individuals such as those coinfected with human immunodeficiency virus (HIV). However, recent reports have described MS in immunocompetent individuals. To describe the characteristics of individuals with MS and associated risk factors, a review of case reports published from 2014 to 2018 was conducted. Out of 45 published case reports, 33 cases (73%) occurred in HIV-positive individuals with majority having CD4 counts <500 cells/mm3. Of the 12 cases (27%) in HIV-negative individuals, half had comorbidities such as diabetes mellitus, alcoholism, drug abuse, psoriasis, and hepatitis. The most frequent manifestation of MS was ulceronodular cutaneous lesions with central adherent crust, which affected the face, trunk, and limbs. Given the increasing number of MS regardless of the immune status, dermatologists and general practitioners should be vigilant to allow early diagnosis and treatment, hence reducing their morbidity.
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Affiliation(s)
- O Wibisono
- Servicio de Dermatología y Venereología, Facultad de Medicina de la Universidad de Hasanuddin, Makassar, Indonesia; Hospital Dr. Wahidin Sudirohusodo, Makassar, Indonesia.
| | - I Idrus
- Servicio de Dermatología y Venereología, Facultad de Medicina de la Universidad de Hasanuddin, Makassar, Indonesia
| | - K Djawad
- Servicio de Dermatología y Venereología, Facultad de Medicina de la Universidad de Hasanuddin, Makassar, Indonesia; Hospital Dr. Wahidin Sudirohusodo, Makassar, Indonesia
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7
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Wibisono O, Idrus I, Djawad K. Malignant Syphilis: A Systematic Review of the Case Reports Published in 2014-2018. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00135-6. [PMID: 33811833 DOI: 10.1016/j.ad.2021.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/26/2021] [Accepted: 02/13/2021] [Indexed: 01/01/2023] Open
Abstract
Malignant syphilis (MS) is a rare manifestation of secondary syphilis which mainly occurs in immunocompromised individuals such as those coinfected with human immunodeficiency virus (HIV). However, recent reports have described MS in immunocompetent individuals. To describe the characteristics of individuals with MS and associated risk factors, a review of case reports published from 2014 to 2018 was conducted. Out of 45 published case reports, 33 cases (73%) occurred in HIV-positive individuals with majority having CD4 counts < 500 cells/mm3. Of the 12 cases (27%) in HIV-negative individuals, half had comorbidities such as diabetes mellitus, alcoholism, drug abuse, psoriasis, and hepatitis. The most frequent manifestation of MS was ulceronodular cutaneous lesions with central adherent crust, which affected the face, trunk, and limbs. Given the increasing number of MS regardless of the immune status, dermatologists and general practitioners should be vigilant to allow early diagnosis and treatment, hence reducing their morbidity.
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Affiliation(s)
- O Wibisono
- Servicio de Dermatología y Venereología, Facultad de Medicina de la Universidad de Hasanuddin, Makassar, Indonesia; Hospital Dr. Wahidin Sudirohusodo, Makassar, Indonesia.
| | - I Idrus
- Servicio de Dermatología y Venereología, Facultad de Medicina de la Universidad de Hasanuddin, Makassar, Indonesia
| | - K Djawad
- Servicio de Dermatología y Venereología, Facultad de Medicina de la Universidad de Hasanuddin, Makassar, Indonesia; Hospital Dr. Wahidin Sudirohusodo, Makassar, Indonesia
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8
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Bosch-Amate X, Fustà-Novell X, Morgado-Carrasco D. Cutaneous Ulcers in an Untreated HIV Patient. Dermatol Pract Concept 2021; 11:e2021007. [PMID: 33747620 DOI: 10.5826/dpc.1102a07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2020] [Indexed: 10/31/2022] Open
Affiliation(s)
- Xavier Bosch-Amate
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Xavier Fustà-Novell
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
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9
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Wang Y, Wen Y. An AIDS Patient with Recurrent Multiple Skin Crusted Ulcerations. AIDS Res Hum Retroviruses 2021; 37:1-3. [PMID: 32981329 DOI: 10.1089/aid.2020.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Malignant syphilis is considered a rare disease, more commonly affecting individuals with poor immunity. We report a case of acquired immune deficiency syndrome (AIDS) with repeated crusted ulcerations. Our report shows the typical skin lesions of malignant syphilis and a reinfection with the same rashes. A 22-year-old homosexual male was admitted to hospital for fever and ulcerations with overlying brown-black rupioid crusts. Then he was confirmed human immunodeficiency virus infection. Malignant syphilis was diagnosed by positive markers and biopsy pathology. After application of benzathine penicillin for 3 weeks, the symptoms improved and rapid plasma regain (RPR) decreased from 1:64 to 1:4 in 8 months. But the patient appeared with rashes that was accurately the same with rashes before 13 months later, and RPR rose to 1:128, which was likely to be reinfection after frequent sexual activity. And he responded well to doxycycline treatment. Although the clinical manifestations of malignant syphilis are severe, the response to the therapy of penicillin and doxycycline are excellent, even with repeated infection.
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Affiliation(s)
- Yu Wang
- Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Ying Wen
- Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, Shenyang, China
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10
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Lesiones costrosas a estudio. Enferm Infecc Microbiol Clin 2020; 38:498-499. [DOI: 10.1016/j.eimc.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 11/22/2022]
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11
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Wu CY, Lo CY, Liang CW, Jee SH, Chu CH. Rapidly evolving papulonecrotic eruption in a middle-aged man. Int J Dermatol 2019; 59:687-689. [PMID: 31829439 DOI: 10.1111/ijd.14733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/06/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Chen-Yu Wu
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
| | - Cheng-Yu Lo
- Department of Pathology, Cathay General Hospital, Taipei, Taiwan
| | - Cher-Wei Liang
- Department of Pathology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Shiou-Hwa Jee
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan.,Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ho Chu
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan.,Department of Dermatology, Hsinchu Cathay General Hospital, Hsinchu, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
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12
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García-Souto F, Cases-Mérida S, Sosa-Moreno F, Escudero-Ordoñez J. Diffuse papules, nodules, and ulcers in an adult man. Int J Dermatol 2019; 59:e133-e134. [PMID: 31556101 DOI: 10.1111/ijd.14650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 11/28/2022]
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13
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Yıldızhan IK, Şanlı HE, Çetinkaya H, Akay BN, Koçyiğit P, Kundakçı N. A rare case of malignant syphilis after adalimumab therapy due to Crohn's disease associated with bariatric surgery. Diagn Microbiol Infect Dis 2019; 95:89-92. [PMID: 31279583 DOI: 10.1016/j.diagmicrobio.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/05/2019] [Accepted: 04/20/2019] [Indexed: 11/15/2022]
Abstract
Malignant syphilis (also known lues maligna) is a rare and severe variant of secondary syphilis. It is most commonly seen in patients who are infected with human immunodeficiency virus (HIV), and rarely, it can occur in immunocompetent individuals. The exact mechanism of the development of malignant syphilis is not clear. It could probably be associated with immunosuppression, inappropriate immune response of the host, or virulent strain of Treponema pallidum. Coexistence of immunosuppression and inappropriate immune response may predispose to develop malignant syphilis in HIV-infected patients with immune reconstitution inflammatory syndrome. Herein, we report the first case of malignant syphilis after adalimumab therapy for Crohn's disease due to bariatric surgery and discuss the underlying possible pathogenic mechanisms.
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Affiliation(s)
| | | | - Hülya Çetinkaya
- Department of Gastoenterology, Ankara University School of Medicine
| | - Bengü Nisa Akay
- Department of Dermatology, Ankara University School of Medicine
| | - Pelin Koçyiğit
- Department of Dermatology, Ankara University School of Medicine
| | - Nihal Kundakçı
- Department of Dermatology, Ankara University School of Medicine
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14
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Zhu L, Shi M, Peng RR, Gu X, Guan Z, Xu H, Zhou P. Neurosyphilis is more common in malignant syphilis: A case series and review of the literature. Int J STD AIDS 2019; 30:779-785. [PMID: 31142223 DOI: 10.1177/0956462419826710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Malignant syphilis is a rare skin manifestation of secondary syphilis, which has been reported primarily in the HIV-infected population. This study aimed to investigate the relationship between HIV infection, malignant syphilis, and neurosyphilis through a systematic chart review of 26 malignant syphilis patients seen at our hospital. We also performed a literature review of 83 reported malignant syphilis cases since 1987, when the first case of malignant syphilis co-infected with HIV was reported. We found there was no direct association between HIV infection and malignant syphilis or neurosyphilis. In contrast, we found that much higher proportion (30%) of malignant syphilis patients develop concurrent neurosyphilis compared to those with the common type of secondary syphilis (13.1%). Physicians should be aware of the fact that neurosyphilis is more common among patients with malignant syphilis and the importance of investigating for neurosyphilis in such patients.
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Affiliation(s)
- Lin Zhu
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Mei Shi
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Rui-Rui Peng
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Xin Gu
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Zhifang Guan
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Huanbin Xu
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
| | - Pingyu Zhou
- Department of Sexually Transmitted Disease Institute, Shanghai Skin Disease Hospital, Shanghai, China
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15
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Forrestel AK, Kovarik CL, Katz KA. Sexually acquired syphilis: Historical aspects, microbiology, epidemiology, and clinical manifestations. J Am Acad Dermatol 2019; 82:1-14. [PMID: 30986477 DOI: 10.1016/j.jaad.2019.02.073] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/10/2019] [Accepted: 02/12/2019] [Indexed: 01/03/2023]
Abstract
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.
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Affiliation(s)
- Amy K Forrestel
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth A Katz
- Department of Dermatology, Kaiser Permanente, San Francisco, California
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16
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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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17
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Mitteldorf C, Plumbaum H, Zutt M, Schön MP, Kaune KM. CD8‐positive pseudolymphoma in lues maligna and human immunodeficiency virus with monoclonal T‐cell receptor‐beta rearrangement. J Cutan Pathol 2018; 46:204-210. [DOI: 10.1111/cup.13390] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/27/2018] [Accepted: 11/05/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Christina Mitteldorf
- Department of Dermatology, Venereology and AllergologyUniversity Medical Centre Göttingen Göttingen Germany
| | - Heidi Plumbaum
- Department of PathologyKlinikum Bremen‐Mitte Bremen Germany
| | - Markus Zutt
- Department of Dermatology and AllergologyKlinikum Bremen‐Mitte Bremen Germany
| | - Michael P. Schön
- Department of Dermatology, Venereology and AllergologyUniversity Medical Centre Göttingen Göttingen Germany
| | - Kjell M. Kaune
- Department of Dermatology and AllergologyKlinikum Bremen‐Mitte Bremen Germany
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18
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Pradhan S, Sirka CS, Panda M, Baisakh M. Lues Maligna in an Immunocompetent Female. Indian Dermatol Online J 2018; 9:344-346. [PMID: 30258808 PMCID: PMC6137667 DOI: 10.4103/idoj.idoj_277_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Swetalina Pradhan
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Chandra S Sirka
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Maitreyee Panda
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Manas Baisakh
- Department of Pathology, Prolife Diagnostics, Bhubaneswar, Odisha, India
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19
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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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Bjekić M. Lues Maligna as an Initial Presentation of Underlying HIV Infection in a Homosexual Man. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2018. [DOI: 10.1515/sjdv-2017-0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Lues maligna is a rare ulcerative form of secondary syphilis. This clinical entity is predominantly found in patients living with HIV or AIDS. We report a case of a 32-year-old homosexual man with diffuse non-pruritic, papular skin lesions, ulcerated nodules and plaques disseminated on the face, trunk and extremities. The rash was followed by fever, malaise and joint pains. Serological tests for syphilis were positive. The patient was treated with intramuscular penicillin and the lesions resolved completely. Lues maligna was an initial presentation of underlying HIV infection. The HIV seropositivity was confirmed by Western blot analysis. Due to the increased number of syphilis cases and frequent HIV co-infection in Serbia, dermatologists must be able to recognize this condition based on clinical characteristics and risk factors and to diagnose and treat it promptly.
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Affiliation(s)
- Milan Bjekić
- City Institute for Skin and Venereal Diseases, Džordža Vašingtona 17, 11000, Belgrade , Serbia
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Abstract
The number of cases of syphilis continues to rise in the UK, USA and elsewhere and may present to a variety of clinical specialties. We report a complex case of early acquired disseminated syphilis causing an ulceronodular rash (lues maligna), orchitis, osteitis and lung nodules in an immunocompetent man who has sex with men who presented to the genitourinary medicine clinic. Syphilis should be considered in the differential diagnoses of multiple clinical presentations and optimal management should involve multidisciplinary care.
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Affiliation(s)
- Neesha Rockwood
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nneka Nwokolo
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Iregui A, Heilman E, Augenbraun M, Rose M. A 33-Year-Old With Human Immunodeficiency Virus/AIDS and Multiple Skin Lesions. Clin Infect Dis 2017. [DOI: 10.1093/cid/cix386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mena Lora AJ, Braniecki M, Nasir A, Brito M. The great impostor: Lues maligna in an HIV-infected male. SAGE Open Med Case Rep 2017; 5:2050313X17731050. [PMID: 28955441 PMCID: PMC5607913 DOI: 10.1177/2050313x17731050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 08/16/2017] [Indexed: 11/15/2022] Open
Abstract
Lues maligna is a rare severe cutaneous manifestation of secondary syphilis. It is also known as malignant syphilis and ulceronodular syphilis. We report a case of a 58-year-old HIV-infected male who presented with diffuse, pruritic, non-tender, maculo-papular skin lesions, ulcerated nodules and plaques surrounded by an erythematous base. The disseminated skin lesions were at various stages and were located on his back, chest, arms and testicles. Patient had been receiving antiretroviral therapy. Laboratory studies had demonstrated CD4 lymphocyte count of 463 cells/mm3 and an undetectable HIV viral load. Workup revealed a rapid plasma reagin of 1:256 dilutions and the skin biopsy findings were compatible with syphilis. The skin lesions resolved with intramuscular penicillin. We herein describe a rare case of lues maligna in an HIV-infected patient with a preserved immune function and viral suppression. Such skin lesions can mimic fungal or mycobacterial infections and can pose a diagnostic challenge. Even in the modern era, syphilis remains the great impostor. Clinicians must be able to recognize this condition based on clinical characteristics and risk factors to diagnose and treat this condition promptly.
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Affiliation(s)
| | | | - Ayman Nasir
- Ross University School of Medicine, Miramar, FL, USA
| | - Maximo Brito
- The University of Illinois at Chicago, Chicago, IL, USA
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Affiliation(s)
- Russell A Johnson
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Adam M Spivak
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
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Cabrera-Fuentes R, Ortiz-Prieto A, Zulueta-Dorado T, Conejo-Mir J. Fever and ulcerative-necrotic lesions in a 38 years old male. Enferm Infecc Microbiol Clin 2017; 36:386-387. [PMID: 28438351 DOI: 10.1016/j.eimc.2017.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Raquel Cabrera-Fuentes
- Servicio de Dermatología y Venereología, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - Alejandro Ortiz-Prieto
- Servicio de Dermatología y Venereología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Teresa Zulueta-Dorado
- Servicio de Anatomía Patológica, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Julián Conejo-Mir
- Servicio de Dermatología y Venereología, Hospital Universitario Virgen del Rocío, Sevilla, España
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Gevorgyan O, Owen BD, Balavenkataraman A, Weinstein MR. A nodular-ulcerative form of secondary syphilis in AIDS. Proc AMIA Symp 2017; 30:80-82. [PMID: 28127144 PMCID: PMC5242125 DOI: 10.1080/08998280.2017.11929539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
An uncommon variant in the pre-AIDS era, lues maligna is a nodular-ulcerative form of secondary syphilis. We present a case of a 41-year-old man with HIV infection who developed fever, chills, nausea, vomiting, right upper quadrant abdominal pain, weight loss, watery diarrhea, and a painless, nonpruritic rash. He had diffuse nodular-ulcerative lesions in various stages of development. He was found to have a CD4 count of 101 cells/mm3 (22%), an HIV viral load of 2,735,060 copies/mL, and a positive rapid plasma reagin at 1:64. He was started on emtricitabine, tenofovir, and dolutegravir, as well as doxycycline. He was given benzathine penicillin 2.4 million units intramuscularly and within hours developed a Jarisch-Herxheimer reaction. Skin lesions showed signs of healing, and constitutional symptoms improved 48 hours later.
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Affiliation(s)
- Ofelya Gevorgyan
- Department of Medicine, Section of Infectious Diseases, Presence Saint Joseph Hospital, Chicago, Illinois
| | - Benjamin D Owen
- Department of Medicine, Section of Infectious Diseases, Presence Saint Joseph Hospital, Chicago, Illinois
| | - Arvind Balavenkataraman
- Department of Medicine, Section of Infectious Diseases, Presence Saint Joseph Hospital, Chicago, Illinois
| | - Mitchell R Weinstein
- Department of Medicine, Section of Infectious Diseases, Presence Saint Joseph Hospital, Chicago, Illinois
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Sammet S, Draenert R. Case report of three consecutive lues maligna infections in an HIV-infected patient. Int J STD AIDS 2016; 28:523-525. [PMID: 28266263 DOI: 10.1177/0956462416674102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lues maligna is a rare presentation of an infection with Treponema pallidum. Here we report three lues maligna infections with severe dermatological manifestations in a single HIV-1 infected individual. Despite the start of highly active antiretroviral therapy and a substantial increase in CD4 cell count after the first episode, he developed consecutive episodes. We assume a specific immunological predisposition to react to T. pallidum in this patient.
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Affiliation(s)
- Stefanie Sammet
- Medizinische Klinik und Poliklinik IV, Section Infectious Diseases, Klinikum der Universität München, Munich, Germany
| | - Rika Draenert
- Medizinische Klinik und Poliklinik IV, Section Infectious Diseases, Klinikum der Universität München, Munich, Germany
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Abstract
Syphilis is on the increase globally. While recognized more frequently in patients with, HIV/AIDS, it is not unusual among immune competent individuals sometimes presenting with unusual manifestations and/or behaviour. This paper reviews the history and clinical features of syphilis and draws attention to the oral manifestations. CPD/Clinical Relevance: Syphilis should be in the differential diagnosis of oral ulcers or unusual oral lesions.
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Requena CB, Orasmo CR, Ocanha JP, Barraviera SRCS, Marques MEA, Marques SA. Malignant syphilis in an immunocompetent female patient. An Bras Dermatol 2015; 89:970-2. [PMID: 25387504 PMCID: PMC4230668 DOI: 10.1590/abd1806-4841.20143155] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 10/16/2013] [Indexed: 12/31/2022] Open
Abstract
Malignant syphilis is an uncommon manifestation of secondary syphilis, in which
necrotic lesions may be associated with systemic signs and symptoms. Generally it
occurs in an immunosuppressed patient, mainly HIV-infected, but might be observed on
those who have normal immune response. Since there is an exponential increase in the
number of syphilis cases, more diagnoses of malignant syphilis must be expected. We
report a case in an immunocompetent female patient.
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Affiliation(s)
- Camila Bueno Requena
- Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp), Botucatu, SP, Brazil
| | - Cínthia Rosane Orasmo
- Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp), Botucatu, SP, Brazil
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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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de Unamuno Bustos B, Sánchez RB, Carazo JLS, de Míquel VA. Malignant syphilis with ocular involvement in an immunocompetent patient. Int J Dermatol 2013; 53:e258-60. [DOI: 10.1111/ijd.12321] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bertrand J, Labrecque LG, Belisle A, Côté B. Lues maligna and Bell’s palsy: report of a case in a immunocompetent host. Int J Dermatol 2012; 51:1363-5. [DOI: 10.1111/j.1365-4632.2011.05169.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hadaschik E, Hartmann M. Ulcerated nodules in a patient with human immunodeficiency virus. Clin Exp Dermatol 2012; 37:574-5. [DOI: 10.1111/j.1365-2230.2011.04178.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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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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Rallis E, Paparizos V. Malignant syphilis as the first manifestation of HIV infection. Infect Dis Rep 2012; 4:e15. [PMID: 24470922 PMCID: PMC3892643 DOI: 10.4081/idr.2012.e15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 12/21/2011] [Accepted: 01/02/2012] [Indexed: 11/23/2022] Open
Abstract
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 consider it in all HIV-infected individuals with ulceronodular skin lesions.
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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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40
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De Socio GVL, Simonetti S, Tomasini C, Ansidei V, Pasticci MB, Baldelli F. Malignant syphilis with ocular involvement in an HIV-infected patient. Int J STD AIDS 2011; 22:298-300. [PMID: 21571984 DOI: 10.1258/ijsa.2010.010389] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Malignant syphilis is now considered a rare disease, more commonly affecting individuals with poor health, malnutrition or HIV infection. We present a 34-year-old man with HIV infection who developed multiple atypical cutaneous ulcerations, leonine facies, a scleral nodule and keratitis with visual loss. The diagnosis of malignant syphilis was delayed due to the insidious presentation, but was confirmed via immunohistochemical (IHC) staining with anti-Treponema antibodies of a skin biopsy. Significant clinical improvement was observed following a 15-day course of penicillin and tigecycline therapy. In advanced HIV disease, cutaneous manifestations are often difficult to identify and present a challenge for the clinician. Clinical manifestations of secondary syphilis vary greatly, earning the epigram of 'the great imitator'. It is important to recognize atypical presentations of syphilis, especially among HIV-infected individuals. Unlike historical cases of malignant syphilis, Treponema pallidum was found in the tissue section using IHC staining methods. We emphasize the importance of lues maligna in the differential diagnosis of HIV-infected patients with diffuse ulceronodular lesions as well as the usefulness of histological investigations and IHC studies.
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Affiliation(s)
- G V L De Socio
- Department of Infectious Diseases, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
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41
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Kelly JD, LeLeux TM, Citron DR, Musher DM, Giordano TP. Ulceronodular syphilis (lues maligna praecox) in a person newly diagnosed with HIV infection. BMJ Case Rep 2011; 2011:bcr.12.2010.3670. [PMID: 22689612 DOI: 10.1136/bcr.12.2010.3670] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In this case of secondary syphilis, pustular lesions progressed rapidly to painful ulcerative lesions in a patient with early HIV infection. This rapidly progressive form of early syphilis has historically been called lues maligna praecox, a severe form of noduloulcerative secondary syphilis. Serologic tests for syphilis were positive and biopsy showed forms consistent with Treponema pallidum in the lesions. This case demonstrates how HIV infection may affect presentation and diagnosis of secondary syphilis.
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Affiliation(s)
- John D Kelly
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
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Abstract
PURPOSE OF REVIEW Clinicians should be aware of the shift in the cutaneous infectious disease burden in human immunodeficiency virus-infected individuals as a reflection of immune restoration in the era of highly active antiretroviral therapy (HAART). RECENT FINDINGS As in the general population but to greater extent, methicillin-resistant Staphylococcus aureus (MRSA) soft-tissue infection is a rising problem among those with human immunodeficiency virus (HIV). Human papilloma virus (HPV) is exceedingly prevalent and persistent despite HAART, and HPV-associated malignancy is increasing as those with HIV live longer. Herpes, syphilis, and Kaposi's sarcoma continue to plague individuals with HIV. Immune reconstitution inflammatory syndrome (IRIS) is common and often presents with infectious cutaneous manifestations. SUMMARY This review implicates the importance of the acknowledgment of MRSA infections risk factors, screening for HPV-related neoplasia, continuance of trials to establish the efficacy of herpes vaccines, and awareness of prevalent cutaneous infections presenting with IRIS in those with HIV.
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Yanagisawa N, Ando M, Imamura A, Akagi K, Horiguchi SI, Suganuma A, Ajisawa A. Pathologically confirmed malignant syphilis in an HIV-infected patient. Intern Med 2011; 50:2423-6. [PMID: 22001480 DOI: 10.2169/internalmedicine.50.5605] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of pathologically confirmed malignant syphilis in an HIV-infected patient. Physical examinations revealed ulceronecrotic skin lesions. Skin biopsies demonstrated syphilis spirochetes on immunohistochemical stain, and syphilis serological titers were positive. Treatment with intravenous penicillin G was begun, and complete resolution of the skin lesions was observed. A rapid plasma reagin titer test performed 3 months after treatment revealed a 4-fold reduction in the titer, indicating successful treatment.
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Affiliation(s)
- Naoki Yanagisawa
- Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, Japan.
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