Malignant syphilis: an early feature of underlying HIV infection in an MSM patient

Introduction

Co-infection of human immunodeficiency virus (HIV) with syphilis is common and has significant clinical consequences. HIV infection can change the course and clinical manifestations of syphilis, resulting in atypical syphilis. A rare feature of this infection is malignant syphilis, which frequently resembles other skin lesions and poses a challenge in diagnosis. This report aims to describe a case of malignant syphilis in an HIV-positive patient.

Case report

A 33-year-old man who has sex with men (MSM) came to the dermato-venereology outpatient clinic with chief complaints of ulcerative lesions on the face, trunk, arms, palms, and legs for the past two months. The patient complained of fever, chills, and decreased appetite two weeks prior to presentation. A dermatological examination showed numerous well-demarcated ulcerated plaques and nodules partially covered with crust. Reactive results were found on syphilis serologic tests with high titers. The test for HIV was reactive, with a CD4 cell count of 219 cells/mm3. The patient was then diagnosed with malignant syphilis and received treatment in the form of benzathine penicillin injection 2.4 million units once a week for three consecutive weeks. After treatment, the skin lesions and syphilis serologic titer improved.

Conclusions

Secondary syphilis in patients with HIV infection may present as an atypical variant. As reported in this case, malignant syphilis should always be considered in the differential diagnosis when ulcerative and necrotic lesions are observed in individuals with HIV infection.

Malignant syphilis in an immunocompromised female: A case report from Northeast India

Malignant syphilis (lues maligna) is a rare form of secondary syphilis, first described by Bazin in 1859, frequently associated with HIV infection. The resurgence of syphilis in the recent times has been attributed to rise in HIV infection. Malignant syphilis is characterized by the presence of pleomorphic multiple round-to-oval papules, papulopustules, or nodules with ulceration, without central clearing, and occasionally exhibit a lamellate brown to black rupioid crust with prodromal symptoms. We herein report a case of early malignant syphilis in a young immunocompromised patient who was HIV positive and noncompliant to antiretroviral therapy, from Northeast India. The HIV/AIDS epidemic is rising at an alarming rate in this part of the country which has thus led to an increase in the number of other sexually transmitted infections.

Malignant syphilis in a young woman: A case report

Malignant syphilis (MS) is a rare dermatological manifestation of secondary syphilis. This case report describes a young woman that presented with a 15-day history of generalized condyloma lata and seborrheic dermatitis-like lesions at various stages. Laboratory tests showed a toluidine red unheated serum test titre of 1:128 and Treponema pallidum particle agglutination positivity. Serology for HIV antibodies was repeatedly negative. MS was diagnosed according to established MS diagnostic criteria. The lesions regressed after treatment with 2 400 000 units penicillin G benzathine by intramuscular injection weekly for three consecutive weeks. MS is more frequently associated with HIV-infected patients, which makes this current case more interesting because MS in HIV-negative patients has rarely been reported.

An AIDS Patient with Recurrent Multiple Skin Crusted Ulcerations

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.

[Malignant syphilis in a patient with HIV infection]

Malignant syphilis occurs frequently in patients infected with human immunodeficiency virus (HIV) and presents with cutaneous nodular lesions that tend to ulcerate. Non caseating granulomas are among the most conspicuous histopathological findings and require differential diagnosis with other infectious and non-infectious granulomatous conditions. The evolution of the disease is usually favourable with penicillin treatment. We present the case of an HIV-positive patient who meets diagnostic criteria for malignant syphilis and alert on this infrequent granulomatous entity.

Malignant Syphilis in an Immunocompetent Adult Male

The occurrence of malignant syphilis in an immunocompetent individual is rare. We present malignant syphilis in a 35-year-old immunocompetent male who presented with a 1-month history of noduloulcerative lesions on the torso. Examination revealed multiple pustules, nodules, and deep-seated ulcers distributed on the trunk, face, and upper and lower limbs. Characteristic morphology of lesions, positive serological tests for syphilis, characteristic histopathology, and resolution of lesions following institution of penicillin therapy confirmed the clinical diagnosis of malignant syphilis.

Malignant lues in an immunocompetent patient

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.

Malignant syphilis with human immunodeficiency virus infection

Malignant syphilis or Lues maligna, commonly reported in the pre-antibiotic era, has now seen a resurgence with the advent of human immunodeficiency virus (HIV). Immunosuppression and sexual promiscuity set the stage for this deadly association of HIV and Treponema pallidum that can manifest atypically and can prove to cause diagnostic problems. We report one such case in a 30-year-old female who responded favorably to treatment with penicillin.