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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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2
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Karanfilian KM, Almohssen AA, Kapila R, Schwartz RA. Malignant syphilis: a new and revised definition. Int J Dermatol 2023; 62:369-375. [PMID: 36250867 DOI: 10.1111/ijd.16444] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 08/07/2022] [Accepted: 09/22/2022] [Indexed: 12/01/2022]
Abstract
Malignant syphilis is a rare, severe variant of secondary syphilis that primarily affects immunocompromised patients. Historically, the clinical presentation included a prodrome of constitutional symptoms followed by the development of characteristic skin lesions. The definition of malignant syphilis has not been updated since it was first described as only a cutaneous manifestation. In recent years, syphilis has reemerged as a major public health issue, particularly in men who have sex with men (MSM) and patients with HIV. With increasing rates of syphilis in the HIV-positive population, the systemic manifestations of malignant syphilis have become more apparent. We propose a revised definition and elucidate why the term malignant syphilis should be expanded to include systemic manifestations, stressing musculoskeletal, central nervous system, ocular, ear, cardiovascular, rectal, liver, lung, and renal involvement. This updated definition is dramatically expanded to reflect its systemic manifestations. Recognition of these manifestations may prevent devastating long-term effects.
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Affiliation(s)
| | | | - Rajendra Kapila
- Infectious Disease, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Robert A Schwartz
- Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, NJ, USA
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3
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Mehta N, Bhari N, Gupta S. Asian guidelines for syphilis. J Infect Chemother 2022; 28:1084-1091. [PMID: 35527175 DOI: 10.1016/j.jiac.2022.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/01/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Nikhil Mehta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Neetu Bhari
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
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4
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Sugishita Y, Kurita J, Sugawara T, Ohkusa Y. Higher Incidence of Syphilis among Patients with HIV Infection: Population Study using Surveillance Data of Tokyo, Japan. TOHOKU J EXP MED 2021; 251:39-46. [PMID: 32448819 DOI: 10.1620/tjem.251.39] [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] [Indexed: 11/18/2022]
Abstract
In Japan, the reported cases of syphilis have been increasing since 2011 especially in large cities such as Tokyo. The objective of this study was to evaluate the risk of HIV infection for syphilis co-infection on the population of Tokyo, Japan. We analyzed data of syphilis cases obtained from additional surveillance by the Tokyo Metropolitan Government in 2018, including those with human immunodeficiency virus (HIV) infection as well as data of HIV/acquired immunodeficiency syndrome (AIDS) cases during 1985-2017. We calculated the incidence of symptomatic syphilis cases among HIV-infected or non-HIV-infected individuals. Similarly, we calculated the incidence of syphilis, including asymptomatic cases, among each population. The relative risk of HIV infection for syphilis, including or excluding asymptomatic syphilis cases, was estimated. The relative risk was calculated by dividing the incidence of syphilis in the HIV-infected population by that in the non-HIV-infected population. Of the 1,775 syphilis cases reported in 2018, 172 cases were infected with HIV, 575 cases were uninfected, and the remainder were either unknown or not reported. The cumulative number of HIV/AIDS cases during 1985-2017 in Tokyo was 9,629; among them, 172 were co-infected with syphilis. The relative risk of HIV infection for syphilis was estimated as 423.29 if asymptomatic syphilis cases were included, and 372.37 if they were excluded. These results showed an extremely high risk of HIV infection. Since many syphilis cases have unknown or unreported HIV infection status, reduction of these cases might contribute to more reliable estimation of HIV infection risk.
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Affiliation(s)
- Yoshiyuki Sugishita
- Infectious Disease Control Section, Health and Safety Division, Bureau of Social Welfare and Public Health, Tokyo Metropolitan Government.,National Institute of Infectious Diseases
| | - Junko Kurita
- Department of Nursing, Faculty of Nursing, Tokiwa University
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5
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Wang P, Li RQ, Wang L, Yang WT, Zou QH, Xiao D. Proteomic Analyses of Acinetobacter baumannii Clinical Isolates to Identify Drug Resistant Mechanism. Front Cell Infect Microbiol 2021; 11:625430. [PMID: 33718272 PMCID: PMC7943614 DOI: 10.3389/fcimb.2021.625430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/11/2021] [Indexed: 12/25/2022] Open
Abstract
Acinetobacter baumannii is one of the main causes of nosocomial infections. Increasing numbers of multidrug-resistant Acinetobacter baumannii cases have been reported in recent years, but its antibiotic resistance mechanism remains unclear. We studied 9 multidrug-resistant (MDR) and 10 drug-susceptible Acinetobacter baumannii clinical isolates using Label free, TMT labeling approach and glycoproteomics analysis to identify proteins related to drug resistance. Our results showed that 164 proteins exhibited different expressions between MDR and drug-susceptible isolates. These differential proteins can be classified into six groups: a. proteins related to antibiotic resistance, b. membrane proteins, membrane transporters and proteins related to membrane formation, c. Stress response-related proteins, d. proteins related to gene expression and protein translation, e. metabolism-related proteins, f. proteins with unknown function or other functions containing biofilm formation and virulence. In addition, we verified seven proteins at the transcription level in eight clinical isolates by using quantitative RT-PCR. Results showed that four of the selected proteins have positive correlations with the protein level. This study provided an insight into the mechanism of antibiotic resistance of multidrug-resistant Acinetobacter baumannii.
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Affiliation(s)
- Ping Wang
- Department of Microbiology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Ren-Qing Li
- Institute for Control of Infectious Diseases and Endemic Diseases, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Lei Wang
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wen-Tao Yang
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qing-Hua Zou
- Department of Microbiology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Di Xiao
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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6
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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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7
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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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8
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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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9
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Abstract
PURPOSE OF REVIEW The aim of this review is to highlight recent changes in opportunistic ocular infections (OOIs) in the era of modern combination antiretroviral therapy (cART), in the setting of HIV-infected patients. RECENT FINDINGS Improvements in modern cART has led to a progressive decline in the incidence of OOIs and mortality among patients with AIDS. Not only has there been a decreasing incidence of cytomegalovirus (CMV) retinitis, but there also has been a decline in progression of such retinitis when it does occur in AIDS patients, since the introduction of cART. Nevertheless, CMV retinitis remains the major cause of vision loss in AIDS patients. Although the incidence of CMV retinitis has declined overall, the incidence of ocular syphilis has increased during the cART era. Moreover, the impact of having HIV plays a role with respect to multidrug-resistant (MDR) tuberculosis and has resulted in a high prevalence of presumed ocular tuberculosis in HIV/MDR-TB co-infected patients. Although immune reconstitution uveitis (IRU) has been an important cause of visual deficits in developed countries, OOIs remain an important cause of blindness in the developing world. SUMMARY Reconstituting the immune system with effective cART while increasing accessibility of screening examinations is key to the success of blindness prevent in HIV-infected individuals, particularly in developing countries.
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10
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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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11
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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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12
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Singh S, Sondhi P, Yadav D, Yadav S. Multiple Familial Trichoepitheliomas Presenting as Leonine Facies. Indian Dermatol Online J 2017; 8:358-360. [PMID: 28979872 PMCID: PMC5621199 DOI: 10.4103/idoj.idoj_67_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Trichoepithelioma is a benign tumor of follicular unit. It has been rarely described as the cause of leonine facies. We are presenting a classical case of multiple familial trichoepitheliomas (MFTs) with characteristic histopathological features leading to leonine facies.
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Affiliation(s)
- Sanjay Singh
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Prateek Sondhi
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepika Yadav
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Savita Yadav
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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13
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Frunza-Stefan S, Acharya G, Kazlouskaya V, Vukasinov P, Chiou Y, Thet Z. Immune reconstitution inflammatory syndrome associated with secondary syphilis. Int J STD AIDS 2016; 28:302-305. [PMID: 27566775 DOI: 10.1177/0956462416664469] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Immune reconstitution inflammatory syndrome (IRIS) is a condition associated with paradoxical worsening and/or new onset of an opportunistic infection in HIV patients following the initiation of anti-retroviral therapy or switching to more potent antiretroviral therapy (ART) regimen. Although IRIS associated with many opportunistic infections (OIs) has been well reported, syphilis has very rarely been mentioned in this regard. A 52-year-old male, diagnosed with AIDS six weeks ago, presented with the disseminated non-pruritic painless skin rash. He denied any fever, cough, shortness of breath, and joint pain or swelling. The patient had no similar symptoms, genital ulcers, or any medical illness in the past. CD4 cell count and viral load were 40 cells/mm3 and 280,000 copies/ml, respectively, while screening tests for OIs including rapid plasma reagin test, quantiferon, cryptococcal antigen, and toxoplasma tests were negative at the time of HIV diagnosis. After three days of initiation of anti-retroviral therapy, he developed the above-mentioned skin rash. Repeat rapid plasma regain (RPR) test at this time was also negative. Punch biopsy of the skin lesion demonstrated findings suggestive of secondary syphilitic lesions, which was confirmed by immunostain. The repeat RPR, CD4 cell count, and viral load showed a titer of 1:256, 257 cells/mm3, and 5000 copies/ml, respectively. His skin rashes faded away, and RPR titer trended down on treatment with benzathine penicillin without discontinuation of ART. The presence of an IRIS response does not predict overall HIV or OI treatment responses, and discontinuation of ART is not generally recommended as the benefits of treating HIV infection outweighs the risk associated with IRIS.
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Affiliation(s)
- Simona Frunza-Stefan
- 1 Department of Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY, USA
| | - Gyanendra Acharya
- 1 Department of Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY, USA
| | - Viktoryia Kazlouskaya
- 1 Department of Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY, USA
| | - Paunel Vukasinov
- 1 Department of Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY, USA
| | | | - Zeyar Thet
- 2 Division of Infectious Disease, Department of Internal Medicine, Wyckoff Heights Medical Center, Brooklyn, NY USA
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14
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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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15
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Alves J, António AM, Matos D, Coelho R, Cachão P. Malignant lues in an immunocompetent patient. Int J STD AIDS 2014; 26:518-20. [PMID: 25015934 DOI: 10.1177/0956462414544162] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 06/23/2014] [Indexed: 11/17/2022]
Abstract
Malignant lues is a rare form of secondary syphilis mostly associated with HIV infection. It is an uncommon presentation of syphilis even rarer in immunocompetent patients. We present the case of a 57-year-old homosexual man referred to our department due to a 4-month history of a disseminated, slightly painful, nodular-ulcerative cutaneous eruption associated with low-grade fever, malaise and aesthenia. Regarding the clinical features and serological and histopathological findings, the diagnosis of syphilis maligna was assumed. Serology for HIV was repeatedly negative. This case is interesting, not only because a very uncommon form of secondary syphilis was identified but also for being diagnosed in an immunocompetent patient. Lack of awareness of this type of presentation delays the diagnosis and treatment, leading to an increase in morbidity and spread of infection.
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Affiliation(s)
- João Alves
- Department of Dermatology and Venereology, Garcia de Orta Hospital, Almada, Portugal
| | - Ana Marta António
- Department of Dermatology and Venereology, Garcia de Orta Hospital, Almada, Portugal
| | - Diogo Matos
- Department of Dermatology and Venereology, Garcia de Orta Hospital, Almada, Portugal
| | - Ricardo Coelho
- Department of Dermatology and Venereology, Garcia de Orta Hospital, Almada, Portugal
| | - Pedro Cachão
- Department of Dermatology and Venereology, Garcia de Orta Hospital, Almada, Portugal
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16
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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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17
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Shah N, Owen L, Bhagani S. 'Occam's Scissors': opportunistic infections in advanced HIV infection. BMJ Case Rep 2013; 2013:bcr-2013-009544. [PMID: 23833087 DOI: 10.1136/bcr-2013-009544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors report the case of a new diagnosis of advanced HIV-1 infection with a blood CD4 cell count of 0.003×10(9)/L (2%), presenting with weight loss, night sweats, diarrhoea and anorexia. Symptoms were due to disseminated histoplasmosis (confirmed pulmonary and colonic disease), Pneumocystis pneumonia and oral candidiasis highlighting the limitations of 'Occam's razor' with advanced HIV infection.
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Affiliation(s)
- Nirav Shah
- Department of HIV/Thoracic Medicine, Royal Free Hospital, London, UK.
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18
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Malincarne L, Pasticci MB, Angeli G, Baldelli F, De Socio GV. Syphilis as a diagnosis of liver abnormalities in HIV. ACTA ACUST UNITED AC 2013; 45:703-5. [PMID: 23672509 DOI: 10.3109/00365548.2013.793819] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In order to investigate syphilitic liver involvement in HIV-infected patients, a single-centre retrospective study of a cohort of HIV-infected patients with syphilis was performed at the Infectious Diseases Clinic of Perugia, Italy, between December 2002 and March 2010. Fifty HIV-infected patients were identified with syphilis plus baseline and follow-up liver tests. The following syphilis diagnoses were recorded: 19 secondary (38%), 26 latent (52%), and 5 tertiary/neurosyphilis (12%). Syphilitic hepatitis was found in 5/50 (10%) patients. This finding supports the importance of including syphilis in the differential diagnosis of liver enzyme abnormalities in HIV-infected patients. An early diagnosis of syphilitic hepatitis can lead to rapid normalization of liver function following appropriate therapy, prevents the progression of syphilis, and limits the further spread of sexually transmitted diseases, including HIV.
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Affiliation(s)
- Lisa Malincarne
- Infectious Diseases Clinic, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy.
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19
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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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