1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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.
| |
Collapse
|
4
|
Atypical secondary syphilis presentation in a patient with human immunodeficiency virus infection: a case report. J Med Case Rep 2019; 13:360. [PMID: 31813380 PMCID: PMC6900840 DOI: 10.1186/s13256-019-2291-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/15/2019] [Indexed: 11/15/2022] Open
Abstract
Introduction Untreated syphilis may lead to severe complications. This infection has recently re-emerged in developed countries with a high number of cases coinfected with human immunodeficiency virus. In these patients, the skin lesions of secondary syphilis can be very atypical. Case presentation We report the case of a 38-year-old Bulgarian homosexual man who was coinfected with human immunodeficiency virus and syphilis. His skin contained multiple extensive necrotic lesions with abundant purulent secretion that covered his face, lips, scalp, and torso. Initial clinical diagnoses included varicella pustulosa and staphylococcal dermatitis. Human immunodeficiency virus infection in our patient had been established 2 years earlier in prophylactic studies, but had not been treated. Due to lack of penicillin, he was successfully treated with ceftriaxone, and the skin lesions underwent complete reversal. He also began antiretroviral therapy, which resulted in a significant effect on his immune status. Three months after the onset of antiretroviral therapy, he also achieved optimal viral suppression. Conclusion This case emphasizes the importance of considering cutaneous secondary syphilis in the differential diagnosis of any inflammatory cutaneous disorder in individuals infected with human immunodeficiency virus.
Collapse
|
5
|
Ge G, Li DM, Qiu Y, Fu HJ, Zhang XY, Shi DM. Malignant syphilis accompanied with neurosyphilis in a malnourished patient: A case report. World J Clin Cases 2019; 7:2406-2412. [PMID: 31531338 PMCID: PMC6718795 DOI: 10.12998/wjcc.v7.i16.2406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/09/2019] [Accepted: 07/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Syphilis is a common sexually transmitted disease caused by the Treponema pallidum (T. pallidum). Malignant syphilis is a rare presentation of secondary syphilis. Here, we present a case diagnosed with malignant syphilis accompanied with neurosyphilis.
CASE SUMMARY A 56-year-old man present with a 2-mo history of spreading ulcerous and necrotic papules and nodules covered with thick crusts over the face, trunk, extremities, and genitalia. The patient was diagnosed with malignant syphilis accompanied by neurosyphilis based on the characteristic morphology of the lesions, positive serological and cerebrospinal fluid tests for syphilis, brain magnetic resonance imaging, and histopathology, along with resolution of the lesions following the institution of penicillin therapy. The lesions and neurological condition successfully resolved after a course of treatment with penicillin.
CONCLUSION We suggest that neurosyphilis should be considered whenever people have psychiatric symptoms without cutaneous lesions or human immunodeficiency virus.
Collapse
Affiliation(s)
- Gai Ge
- Jining Medical University, Jining 272067, Shandong Province, China
| | - Dong-Mei Li
- Georgetown University Medical Center, Washington, DC 20057, United States
| | - Ying Qiu
- Department of Dermatology, Jining No. 1 People’s Hospital, Jining 272067, Shandong Province, China
| | - Hong-Jun Fu
- Department of Dermatology, Jining No. 1 People’s Hospital, Jining 272067, Shandong Province, China
| | - Xiang-Yu Zhang
- Department of Pathology, Jining No. 1 People’s Hospital, Jining 272067, Shandong Province, China
| | - Dong-Mei Shi
- Department of Dermatology and Laboratory of Medical Mycology, Jining No. 1 People’s Hospital, Jining 272067, Shandong Province, China
| |
Collapse
|
6
|
Rossi M, Bruno V, Arena J, Cammarota Á, Merello M. Challenges in PD Patient Management After DBS: A Pragmatic Review. Mov Disord Clin Pract 2018; 5:246-254. [PMID: 30363375 PMCID: PMC6174419 DOI: 10.1002/mdc3.12592] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 01/01/2018] [Accepted: 01/15/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or internal globus pallidus (GPi) represents an effective and universally applied therapy for Parkinson's disease (PD) motor complications. However, certain procedure-related problems and unrealistic patient expectations may detract specialists from indicating DBS more widely despite significant clinical effects. METHODS This review provides a pragmatic educational summary of the most conflicting postoperative management issues in patients undergoing DBS for PD. RESULTS DBS in PD has been associated with certain complications and post-procedural management issues, which can complicate surgical outcome interpretation. Many PD patients consider DBS outcomes negative due to unfulfilled expectations, even when significant motor symptom improvement is achieved. Speech, gait, postural stability, and cognition may worsen after DBS and body weight may increase. Although DBS may induce impulse control disorders in some cases, in others, it may actually improve them when dopamine agonist dosage is reduced after surgery. However, apathy may also arise, especially when dopaminergic medication tapering is rapid. Gradual loss of response with time suggests disease progression, rather than the wearing off of DBS effects. Furthermore, implantable pulse generator expiration is considered a movement disorder emergency, as it may worsen parkinsonian symptoms or cause life-threatening akinetic crises due to malignant DBS withdrawal syndrome. CONCLUSION Major unsolved issues occurring after DBS therapy preclude complete patient satisfaction. Multidisciplinary management at experienced centers, as well as careful and comprehensive delivery of information to patients, should contribute to make DBS outcome expectations more realistic and allow post procedural complications to be better accepted.
Collapse
Affiliation(s)
- Malco Rossi
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
| | - Verónica Bruno
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
- Argentine National Scientific and Technological Research Council (CONICET)Buenos AiresArgentina
| | - Julieta Arena
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
| | - Ángel Cammarota
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
| | - Marcelo Merello
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
- Argentine National Scientific and Technological Research Council (CONICET)Buenos AiresArgentina
| |
Collapse
|
7
|
Ortigosa YM, Bendazzoli PS, Barbosa AM, Ortigosa LCM. Early malignant syphilis. An Bras Dermatol 2017; 91:148-150. [PMID: 28300925 PMCID: PMC5325024 DOI: 10.1590/abd1806-4841.20164491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 05/05/2015] [Indexed: 12/31/2022] Open
Abstract
Early malignant syphilis is a rare and severe variant of secondary syphilis. It is clinically characterized by lesions, which can suppurate and be accompanied by systemic symptoms such as high fever, asthenia, myalgia, and torpor state. We report a diabetic patient with characteristic features of the disease showing favorable evolution of the lesions after appropriate treatment.
Collapse
Affiliation(s)
- Yara Martins Ortigosa
- Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp) - São Paulo (SP), Brazil
| | | | | | | |
Collapse
|
8
|
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
| |
Collapse
|
9
|
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.
Collapse
|