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Secondary Syphilis (secondary + syphilis)
Selected AbstractsMultiple condylomata lata: a case reportINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 1 2008Haikang Hua MD An unusual form of secondary syphilis was reported, characterized by multiple papules involving the intertriginous areas. The skin biopsy was performed but was nondiagnostic. Later on, serologic tests confirmed the diagnosis. This patient is presented to emphasize the importance of considering syphilis in any patient with an at-risk sexual history and popular verrucous lesions of the skin folds. [source] Immunoperoxidase technique for detecting spirochetes in tissue sections: comparison with other methodsINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 8 2000Robert George Phelps MD Background With the increasing incidence of human immunodeficiency virus (HIV) infection and immunosuppressive therapy, the incidence of syphilis has been increasing. Given the fact that the above conditions may mask or obscure the usual clinical signs and symptoms of syphilis, a means of enhanced detection is essential. Aims,methods The purpose of this study was to determine whether an immunoperoxidase method using an antibody against treponemes would increase the sensitivity and specificity of diagnosis in biopsies of patients with secondary syphilis. This was compared to serology and silver stain in cases of known syphilis. Results Immunoperoxidase for treponemes was at least as sensitive (9/10) as pathology (9/10), and more sensitive than conventional silver stain (6/10) or serology (7/10). Conclusions In those equivocal cases of secondary syphilis, where confirmation is essential, immunoperoxidase for treponemes may be a useful adjunct. [source] ,Lues maligna" bei insulinpflichtigem Diabetes mellitusJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 10 2005"Lues maligna" in a female patient with diabetes Zusammenfassung Bei einer 40-jährige Patientin mit insulinpflichtigem Diabetes mellitus traten innerhalb weniger Wochen vor allem am Stamm multiple bis 2,5,cm große, lividrote Knoten und Plaques auf, die rasch ulzerierten. Einige Monate zuvor habe beim Partner ein kleines Ulkus am Penis bestanden. Die HIV-negative Patientin hatte eine hochtitrig positive Syphilisserologie (TPPA-Titer >,1 : 20.480, VDRL-Titer 1 : 128). Die nüchtern Blutglukosewerte lagen über 275,mg/dl. Nach Ausschluss einer Neurolues stellten wir die Diagnose einer ,Lues maligna" bei schlecht eingestelltem Diabetes mellitus. Unter einer Therapie mit 3,Injektionen Benzylpenicillin-Benzathin (2,4,Mio.,IE) i. m. in wöchentlichen Abständen und Einstellung des Diabetes heilten die Hautveränderungen komplett ab. Im Verlauf war der VDRL-Titer negativ. Die ,Lues maligna" tritt seit einigen Jahren wieder gehäuft auf und wird vor allem bei HIV-positiven Männern beobachtet. Das Auftreten dieser Erkrankung bei durch Diabetes mellitus bedingter Immunsuppression ist ausgesprochen selten. Summary A 40-year-old female patient with diabetes mellitus presented with multiple erythematous ulcerated nodules and plaques predominantly on the trunk. A few months ago her partner had a small ulcer on the penis. She was HIV negative but showed markedly elevated syphilis serology titers (TPPA titer >,1 : 20.480, VDRL titer 1 : 128). The serum glucose levels exceeded 275,mg/dl. After exclusion of neurological involvement, we made the diagnosis of ,lues maligna" arising in the setting of diabetes mellitus. The patient was treated with 2.4 million units benzathine penicillin intramuscularly weekly for three weeks. Simultaneously, diabetes therapy was improved with insulin injections. The syphilitic lesions cleared rapidly. In the follow-up VDRL titer was negative. ,Lues maligna" is an unusual ulcerative variant of secondary syphilis which has been observed more frequently in HIV-infected patients in the last years. The occurrence of this aggressive variant in the clinical setting of diabetes mellitus is extremely rare. [source] Secondary Syphilis Presenting as Cutaneous T-Cell Lymphoma in an HIV-Positive PatientJOURNAL OF CUTANEOUS PATHOLOGY, Issue 1 2005A. Laungani We present the case of an HIV-positive 38-year-old Caucasian male with a history of fevers, chills, and disseminated nonpruritic erythematous papules that began on his abdomen. An initial skin biopsy revealed a lymphohistiocytic infiltrate at the dermoepidermal junction, exocytosis of atypical lymphocytes, and minimal spongiosis. Immunohistochemistry showed increased CD8-positive cells but only scattered CD30-positive cells. PCR analysis demonstrated T-cell receptor gamma gene rearrangement. RPR, blood and tissue cultures were all negative. The patient was thought to have a cytotoxic cutaneous T-cell lymphoma. Over time, the lesions progressed to the palms and soles and the patient remained febrile. Repeat biopsy demonstrated a lichenoid interface dermatitis with a superficial and deep perivascular, interstitial, and periadnexal lymphohistiocytic infiltrate and the formation of epithelioid granulomas throughout the dermis. The epidermis showed blurring of the dermoepidermal junction, spongiosis, and exocytosis of lymphocytes and neutrophils. Few spirochetes were demonstrated by Steiner stain. Repeat RPR and FTA-Abs serologies were positive. The patient was diagnosed with late secondary syphilis and was successfully treated with benzathine penicillin. This case demonstrates that atypical lymphoid infiltrates can simulate mycosis fungoides in an HIV-positive patient with secondary syphilis and also reiterates that syphilis is a great mimicker of other entities. 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