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Jimenez D, Rabe MS, Agarwal AN, Dalton SR, Anstead GM. An Exuberant Case of Ulceronodular-Rupioid (Malignant) Syphilis in an HIV Patient: A Proposal for New Diagnostic Criteria. Infect Dis Rep 2024; 16:499-518. [PMID: 38920894 PMCID: PMC11203149 DOI: 10.3390/idr16030038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/25/2024] [Accepted: 06/04/2024] [Indexed: 06/27/2024] Open
Abstract
We report the case of a 28-year-old male with uncontrolled human immunodeficiency virus (HIV) infection who presented with extensive ulcerated lesions with dark lamellated crusting on his face, torso, and limbs. The patient had a rapid plasma reagin (RPR) titer of 1:512, indicative of syphilis. A skin biopsy revealed granulomata surrounded by lymphocytes, histiocytes, and plasma cells, with spirochetes visible on immunohistochemical staining. The patient's rash resolved with hyperpigmented scarring after penicillin and doxycycline treatment. This severe form of secondary syphilis has been termed malignant syphilis, lues maligna, ulceronodular syphilis, or rupioid syphilis. We propose a single descriptive name for this entity, ulceronodular-rupioid syphilis. In 1969, Fisher proposed criteria for malignant syphilis based on lesion appearance, histopathologic findings, high RPR values, and rapid response to treatment. We found that the Fisher criteria were imprecise with respect to specific histopathologic findings, the quantitation of RPR values, and what constitutes rapid response to treatment. Thus, we examined an additional 74 cases from the literature and propose new diagnostic criteria based on rash appearance, histopathologic characteristics, non-treponemal and treponemal test positivity, and response to therapy. We also found that uncontrolled viremia, and not a low CD4 count, is a major risk factor for ulceronodular-rupioid syphilis in HIV patients.
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Affiliation(s)
- Dennys Jimenez
- Department of Medicine, Division of Infectious Diseases, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA;
| | - Marian Santillan Rabe
- Family-Focused AIDS Clinical Treatment Services Clinic, University Health System, 903 W. Martin St., San Antonio, TX 78207, USA;
| | - Apeksha N. Agarwal
- Department of Pathology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA;
| | - Scott R. Dalton
- Sagis Diagnostics, PLLC, 4131 Directors Row, Houston, TX 77092, USA;
| | - Gregory M. Anstead
- Department of Medicine, Division of Infectious Diseases, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA;
- Family-Focused AIDS Clinical Treatment Services Clinic, University Health System, 903 W. Martin St., San Antonio, TX 78207, USA;
- Medical Service, Division of Infectious Diseases, South Texas Veterans Healthcare System, 7400 Merton Minter Blvd., San Antonio, TX 78229, USA
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2
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Tokano M, Tarumoto N, Imai K, Yamaguchi H, Takeji M, Inayoshi F, Okamoto K, Okumura N, Maesaki S. Malignant syphilis requiring differentiation from Kaposi's sarcoma. IDCases 2024; 36:e01943. [PMID: 38646599 PMCID: PMC11031774 DOI: 10.1016/j.idcr.2024.e01943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 03/19/2024] [Accepted: 04/13/2024] [Indexed: 04/23/2024] Open
Abstract
Malignant syphilis (MS) is a rare variant of secondary syphilis. Also known as rupioid syphilis, MS is characterized by the presence of multiple papules, papulopustules, black lamellate crust that may resemble an oyster shell, or nodules with ulceration lacking central clearing. MS is often associated with immunodeficiency and frequently co-occurs with HIV infection. We here report a case of MS in a patient with HIV infection. HIV infection can cause atypical clinical symptoms of syphilis. In this case, unlike previous cases, cutaneous lesions of MS were limited to the face, making the diagnosis challenging based on clinical findings alone. However, his laboratory findings, appearance of the Jarisch-Herxheimer reaction, and a dramatic response to antibiotic therapy are characteristic of MS, making the diagnosis even more certain. Our case suggests the importance of physicians considering the possibility of MS when observing black-crusted lesions.
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Affiliation(s)
- Mieko Tokano
- Department of Infectious Disease and Infection Control, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
- Department of Allergy and Immunology, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
| | - Norihito Tarumoto
- Department of Infectious Disease and Infection Control, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
| | - Kazuo Imai
- Department of Infectious Disease and Infection Control, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
| | - Hiroshi Yamaguchi
- Department of Pathology, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
| | - Masaaki Takeji
- Department of Dermatology, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
| | - Fumito Inayoshi
- Department of Rheumatology and Applied Immunology, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
| | - Keita Okamoto
- Department of Rheumatology and Applied Immunology, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
| | - Nobuhito Okumura
- Department of Rheumatology and Applied Immunology, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
| | - Shigefumi Maesaki
- Department of Infectious Disease and Infection Control, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
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3
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E Silva LDDA, Silva EV, Silveira HA, Silva HC, Chahud F, León JE, Mesquita ATM. Intraoral primary syphilis mimicking lymphoproliferative disorder. J Cutan Pathol 2024; 51:209-213. [PMID: 38084767 DOI: 10.1111/cup.14567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/13/2023] [Accepted: 11/25/2023] [Indexed: 02/02/2024]
Abstract
Syphilis can mimic, clinically and microscopically, many other diseases. By microscopy, typically syphilis presents with plasma cell infiltration, admixed with lymphocytes and macrophages, in lichenoid and/or perivascular/perineural distribution pattern. When exuberant, this inflammatory infiltrate can mimic a lymphoproliferative disorder (LPD), notably plasma cell neoplasia or lymphoma. To date, about 12 cases of secondary syphilis, all but one in extraoral location, suggesting initially a LPD, have been published. Here, to our knowledge, we report an unusual case of intraoral primary syphilis initially suggesting LPD, notably lymphoid hyperplasia (pseudolymphoma); however, mucosa-associated lymphoid tissue (MALT) lymphoma and follicular lymphoma could not be disregarded. Polyclonality of plasma cells on immunohistochemistry, in strict clinical correlation, was essential to arrive at the correct diagnosis.
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Affiliation(s)
- Larissa Doalla de Almeida E Silva
- Department of Dentistry, Stomatology Clinical, Federal University of Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil
| | - Evânio Vilela Silva
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Heitor Albergoni Silveira
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Herberth Campos Silva
- Department of Dentistry, Stomatology Clinical, Federal University of Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil
| | - Fernando Chahud
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School (FMRP/USP), University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Jorge Esquiche León
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School (FMRP/USP), University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ana Terezinha Marques Mesquita
- Department of Dentistry, Stomatology Clinical, Federal University of Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Minas Gerais, Brazil
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Pipitò L, Medaglia AA, Trizzino M, Bonura S, Gioè C, Di Carlo P, Colomba C, Cascio A. A case of syphilis associated with immune reconstitution inflammatory syndrome and review of the literature. AIDS Res Ther 2023; 20:28. [PMID: 37170352 PMCID: PMC10176857 DOI: 10.1186/s12981-023-00522-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Immune reconstitution inflammatory syndrome (IRIS) associated with syphilis has rarely been described in HIV-infected patients. Diagnosis can be challenging because it is not always possible to discern it from a recent infection or a worsening of an undiagnosed one. CASE PRESENTATION An HIV-positive 42-year-old man with a poor compliance history of antiretroviral therapy presented at our unit and complained of ocular symptoms. Ocular syphilis diagnosis was posed after initial misdiagnosing with cytomegalovirus infection, and antiretroviral therapy compliance improved after switching to a bictegravir-based regimen. Despite intravenous (IV) penicillin, we observed an initial worsening with the appearance of new skin lesions, and IRIS syphilis was suspected. In the literature, 14 cases of IRIS syphilis are described, all regarding male patients. Seven were HIV naïve to therapy, and 7 HIV-experienced with poor therapy compliance. Basal syphilis serology was negative in ten, with subsequent seroconversion after the development of IRIS. IRIS-syphilis development was observed after a median time of 28 days from ART initiation; 10 cases were considered "unmasking-IRIS" and 4 "paradoxical-IRIS". Skin and ocular involvement were the most often reported. In most cases, it was not necessary to use a systemic steroid. A good outcome was reported in 12. CONCLUSIONS Syphilis should be considered in differential diagnosis with other diseases associated with IRIS. A negative syphilis serology before beginning antiretroviral therapy could convey the impression that syphilis has been ruled out. Whereas a high index of suspicion should be maintained when symptoms suggestive of syphilis, such as ocular and skin manifestations, are noticed after therapy has begun.
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Affiliation(s)
- Luca Pipitò
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy
- Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy
- Palermo Fast-Track City, Casa Dei Diritti, Via Libertà 45, 90143, Palermo, Italy
| | - Alice Annalisa Medaglia
- Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy
- Palermo Fast-Track City, Casa Dei Diritti, Via Libertà 45, 90143, Palermo, Italy
| | - Marcello Trizzino
- Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy
- Palermo Fast-Track City, Casa Dei Diritti, Via Libertà 45, 90143, Palermo, Italy
| | - Silvia Bonura
- Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy
- Palermo Fast-Track City, Casa Dei Diritti, Via Libertà 45, 90143, Palermo, Italy
| | - Claudia Gioè
- Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy
- Palermo Fast-Track City, Casa Dei Diritti, Via Libertà 45, 90143, Palermo, Italy
| | - Paola Di Carlo
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy
- Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy
- Palermo Fast-Track City, Casa Dei Diritti, Via Libertà 45, 90143, Palermo, Italy
| | - Claudia Colomba
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy
- Pediatric Infectious Diseases Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, 90127, Palermo, Italy
- Palermo Fast-Track City, Casa Dei Diritti, Via Libertà 45, 90143, Palermo, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, Palermo, Italy.
- Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone", Via del Vespro 129, 90127, Palermo, Italy.
- Palermo Fast-Track City, Casa Dei Diritti, Via Libertà 45, 90143, Palermo, Italy.
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5
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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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6
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Nethers K, Mojica RE, Marks E, Burger R, Saeed S, Steffes W. A case of secondary syphilis masquerading as cutaneous lymphoma. JAAD Case Rep 2021; 14:17-20. [PMID: 34258344 PMCID: PMC8253886 DOI: 10.1016/j.jdcr.2021.05.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kevin Nethers
- Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery Orlando Dermatology Residency Program, Oviedo, Florida
| | - Rafael E Mojica
- Edward Via College of Osteopathic Medicine, Department of Graduate Medical Education, Spartanburg, South Carolina
| | - Etan Marks
- Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery Orlando Dermatology Residency Program, Oviedo, Florida.,Advanced Dermatology and Cosmetic Surgery, Department of Graduate Medical Education, Maitland, Florida
| | - Robin Burger
- Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery Orlando Dermatology Residency Program, Oviedo, Florida.,Advanced Dermatology and Cosmetic Surgery, Department of Graduate Medical Education, Maitland, Florida
| | - Sadia Saeed
- Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery Orlando Dermatology Residency Program, Oviedo, Florida.,Advanced Dermatology and Cosmetic Surgery, Department of Graduate Medical Education, Maitland, Florida
| | - William Steffes
- Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology and Cosmetic Surgery Orlando Dermatology Residency Program, Oviedo, Florida.,Advanced Dermatology and Cosmetic Surgery, Department of Graduate Medical Education, Maitland, Florida
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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: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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8
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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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9
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Mitra D, Singh GK, Mitra B, Talukdar K, Dhillon A, Singh T. A case of primary and secondary syphilis presenting together as immune reconstitution inflammatory syndrome. Indian J Sex Transm Dis AIDS 2021; 42:156-158. [PMID: 34909622 PMCID: PMC8628094 DOI: 10.4103/ijstd.ijstd_58_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 01/19/2021] [Accepted: 02/04/2021] [Indexed: 02/07/2023] Open
Abstract
Immune reconstitution inflammatory syndrome (IRIS) is a condition during the clinical course of HIV infection in which there is paradoxical worsening and/or new onset of opportunistic infections in a HIV-positive patient who has recently been started on anti-retroviral therapy (ART). We present a case of AIDS with CD4 count of 20 cells/μl who presented within 6 weeks of starting ART with a CD4 count of 160 cells/μl and a painless solitary genital ulcer along with annular dark-colored plaques over soles. His screening test for syphilis was negative both during baseline evaluation, prior to initiation of ART, and during his clinical presentation. His disease was confirmed based on a positive treponema pallidum hemagglutination test report and a suggestive skin biopsy. He responded well to three doses of Benzathine Penicillin and continuation of ART. There are very few case reports of syphilis presenting as IRIS and this case is all the more unique as he had features of both primary and secondary syphilis occurring together within 6 weeks of starting ART. This report would reiterate the fact that syphilis and HIV co-infection can alter the natural course of both the diseases and a high index of suspicion is required for treating them.
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Affiliation(s)
- Debdeep Mitra
- Department of Dermatology, Base Hospital Delhi, Base Hospital Delhi Cantt, New Delhi, India,Address for correspondence: Dr. Debdeep Mitra, Base Hospital Delhi Cantt, New Delhi - 110 010, India. E-mail:
| | - Gautam Kumar Singh
- Department of Dermatology, Base Hospital Delhi, Base Hospital Delhi Cantt, New Delhi, India
| | - Barnali Mitra
- Department of Pediatrics, Base Hospital Delhi, Base Hospital Delhi Cantt, New Delhi, India
| | - Krishna Talukdar
- Department of Dermatology, Jorhat Medical College and Hospital, Jorhat, Assam, India
| | - Amen Dhillon
- Department of Dermatology, Base Hospital Delhi, Base Hospital Delhi Cantt, New Delhi, India
| | - Tegveer Singh
- Department of Dermatology, Base Hospital Delhi, Base Hospital Delhi Cantt, New Delhi, India
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10
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Guo H, Li JH. Rupioid syphilis. Assoc Med J 2019. [DOI: 10.1136/bmj.l5932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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11
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Jacobsen E, Tarabadkar ES, Shinohara MM. Generalized fixed drug eruption mimicking CD8+ cutaneous T-cell lymphoma in HIV. J Cutan Pathol 2018; 46:134-137. [PMID: 30328131 DOI: 10.1111/cup.13376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/03/2018] [Accepted: 10/08/2018] [Indexed: 11/27/2022]
Abstract
We present a case of a widespread fixed drug eruption histologically mimicking CD8 positive cutaneous T-cell lymphoma (CTCL). CTCL has several potential histological and clinical mimics, and accurate diagnosis relies on a combination of clinicopathological correlation and molecular studies. We add generalized fixed drug eruption to the list of possible CTCL mimics.
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Affiliation(s)
- Emilie Jacobsen
- University of Washington School of Medicine, Seattle, Washington
| | | | - Michi M Shinohara
- University of Washington Division of Dermatology, Seattle, Washington.,University of Washington Division of Dermatopathology, Seattle, Washington
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12
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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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Yuan Y, Zhang X, Xu N, Wang L, Li F, Zhang P, Miao L, Yang H. Clinical and pathologic diagnosis and different diagnosis of syphilis cervical lymphadenitis. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:13635-13638. [PMID: 26722588 PMCID: PMC4680533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 09/21/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE To study the clinical pathologic characteristics and differential diagnosis of syphilitic cervical lymphadenitis, and to improve the rate of its diagnosis and treatment. METHODS Retrospectively analyzed the clinical history, Trepone pallidum-ELISA (TP-ELISA), rapid plasma regain test (RPR) and routine pathological examination of the patient diagnosed as syphilis lymphadenitis. And review related literatures. RESULTS The main clinical presentation was multiple palpable cervical lymph nodes. The multiple nodes were hard, fixed, and the major diameter of the larger one was 2 cm. The main pathological changes included: the capsule was significantly thickened; reactive hyperplasia of lymphoid follicular with sky star phenomenon; occlusive endovasculitis; perivascular inflammation; the proliferation of epithelioid histiocytes can form granulomas with few multinucleated giant cells; few necrosis. TP-ELISA and RPR were positive. CONCLUSIONS The pathological changes of syphilitic lymphadenitis have a variety of performance with relatively specific and suggestive alterations which requires a combination of clinical history and laboratory test before the diagnosis, and the clinicians can reduce misdiagnosis and missed diagnosis of the disease by increasing vigilance of it.
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Affiliation(s)
- Yufen Yuan
- Department of Pathology, Anyang Tumor HospitalAnyang 455000, Henan, China
| | - Xinlian Zhang
- Department of Dermatology and Venerology, Anyang County Hospital of Traditional ChineseAnyang 455000, China
| | - Nan Xu
- Department of Pathology, Anyang Tumor HospitalAnyang 455000, Henan, China
| | - Libo Wang
- Department of Pathology, Anyang Tumor HospitalAnyang 455000, Henan, China
| | - Fangchao Li
- Department of Laboratory, Anyang Tumor HospitalAnyang 455000, Henan, China
| | - Ping Zhang
- Department of Pathology, Anyang Tumor HospitalAnyang 455000, Henan, China
| | - Lanfang Miao
- Department of Pathology, Anyang Tumor HospitalAnyang 455000, Henan, China
| | - Haijun Yang
- Department of Pathology, Anyang Tumor HospitalAnyang 455000, Henan, China
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