ABSTRACT
Se describe el caso clínico de un paciente de 62 años de edad, quien fue atendido en la consulta de dermatología del Policlínico Aquiles Espinosa Salgado de Las Tunas, por presentar una lesión blanca, de aspecto perlado, de 0,5 cm, en la punta de la lengua. Teniendo en cuenta las características de dicha lesión, se estableció el diagnóstico de sospecha de sífilis secundaria. Se le indicó la prueba serológica para la detección de sífilis, cuyo resultado fue de 128 diluciones, por lo que se confirmó que se trataba de una sifílide opalina, como manifestación de la sífilis en estadio secundario. Se efectuó el control de foco y la fuente de contagio estaba aún sin precisar. Con el tratamiento indicado evolucionó favorablemente, pero se mantuvo el seguimiento clínico y serológico según lo establecido.
The case report of a 62 years patient who was assisted in the Dermatology Service of Aquiles Espinosa Salgado Polyclinic in Las Tunas is described, who presented a 0.5 cm white lesion, of pearly aspect, in the tip of the tongue. Taking into account the characteristics of this lesion the suspected diagnosis of secondary syphilis was established. The venereal disease research laboratory test was ordered and its result was 128 dilutions, reason why an opaline syphilid was confirmed, as a manifestation of syphilis in secondary stage. The focus control was carried out and the source of infection was still without specifying. With the suitable treatment, he had a favorable clinical course, but clinical and serologic follow up was maintained as established.
Subject(s)
Syphilis , Sexually Transmitted Diseases , Communicable Disease Control , Primary Health CareABSTRACT
Syphilis, the "great imitator" of skin diseases, is a chronic systemic infectious disease with a waxing and waning course. Clinical manifestations of syphilis are variable in appearance and have been described for centuries. Especially, secondary syphilis is characterized by large diversity of presentation. They include macular, papular, papulosquamous, syphilis cornee, psoriasiform, annular en cockade, nodular, condylomata lata, malignant syphilis, mucosal lesions, loss of the hairs, and alteration of the nails. Nail involvement of syphilis includes changes on nail plate (syphilitic onychia) or periungual tissue (syphilitic paronychia). A 20-year-old man was presented with multiple erythematous broad eroded surfaced papules and macules on the scrotum and scaly exfoliated patch with erythematous swelling on the right thumb with onychodystrophy and mild tenderness on the nail. Serological screening for syphilis showed increased titer for VDRL (1:16) and TPHA (+). After intramuscular treatments with benzathine penicillin G, the skin lesions on the scrotum cleared within 1 month and the nail dystrophy showed slight improvement.
Subject(s)
Humans , Young Adult , Communicable Diseases , Cytochrome P-450 CYP1A1 , Ethylenediamines , Hair , Mass Screening , Nails , Penicillin G Benzathine , Scrotum , Skin , Skin Diseases , Syphilis , Syphilis, Cutaneous , ThumbABSTRACT
Syphilid represents a great variety of clinical and histological patterns. As such, sometimes it is difficult to make a differential diagnosis from other skin diseases. The histopathologic findings of syphilid are different, according to the clinical types; macular, maculopapular, papulosquamous, and nodular type. Characteristically, there is a marked perivascular infiltration of plasma cells and lymphocytes with endothelial cell swelling in the dermis. Herein, we report a case of syphilid showing the unusual histological pattern of granulomatous inflammation. A 45-year-old male presented with erythematous papules on the scalp, trunk, arms and inguinal area for 2 months. The biopsy specimen showed a chronic granulomatous inflammation with multinucleated giant cells in the dermis. Serologic test for syphilis showed a strong positive, and the patient was diagnosed with secondary syphilis. He was treated with benzathine penicillin G and the skin lesions have successfully disappeared.
Subject(s)
Humans , Male , Middle Aged , Arm , Biopsy , Dermis , Diagnosis, Differential , Endothelial Cells , Ethylenediamines , Giant Cells , Inflammation , Lymphocytes , Penicillin G Benzathine , Plasma Cells , Scalp , Serologic Tests , Skin , Skin Diseases , Syphilis , Syphilis, CutaneousABSTRACT
Cutaneous manifestations of secondary syphilis vary widely. Clinicians learn to consider the "great imitator" when confronting a combination of signs and symptoms that cannot be readily explained. A 29-year-old man presented with a 3-month history of well-circumscribed, scale-covered, erythematous plaque on the proximal part of his penis. On the basis of a serologic test for syphilis and skin biopsy, syphilid was confirmed. We report an unusual case of syphilid that presented with localized penile involvement presenting as a sole manifestation.
Subject(s)
Adult , Humans , Male , Biopsy , Penis , Serologic Tests , Skin , Syphilis , Syphilis, CutaneousABSTRACT
Rupioid syphilid is a type of pustular syphilis which accounts for <2% of cases of secondary syphilis. In pustular syphilis, pustules undergo central necrosis giving rise to "limpet-like" crusts resembling an "oyster shell." When the clinical findings are atypical, a diagnosis is made based on serologic testing. The prozone phenomenon occurs in <1% of patients with primary or secondary syphilis. This is a false negative reaction that occurs when very high antibodies in the serum prevent the formation of the antibody-antigen lattice needed to visualize a flocculation reaction. We report a case of rupioid syphilid in a pregnant woman accompanied by the prozone phenomenon. An accurate diagnosis was delayed because of atypical clinical findings and false-negative serologic results.
Subject(s)
Female , Humans , Antibodies , False Negative Reactions , Flocculation , Necrosis , Pregnant Women , Serologic Tests , Syphilis , Syphilis, CutaneousABSTRACT
Syphilid has been called the "great imitator" of skin disease, and it can have protean clinical manifestations and it may present with unusual lesions. Annular syphilid, which can mimic sarcoid, granuloma annulare, Sweet syndrome or tinea corporis, is a rare variant of syphilid. We report here on a case of annular syphilid that mimicked tinea corporis in a 29-year-old female who showed a three month history of multiple, pruritic, well-demarcated annular scaly erythematous patches with central clearing and an elevated border on the trunk and both upper extremities. Direct mycological examination and culture did not result in finding any fungal elements, and annular syphilid was confirmed according to the histopathologic and serologic findings. She and her boyfriend were treated with benzathine penicillin G, and the skin lesions disappeared completely.
Subject(s)
Adult , Female , Humans , Ethylenediamines , Granuloma Annulare , Hydrazines , Penicillin G Benzathine , Skin , Skin Diseases , Sweet Syndrome , Syphilis, Cutaneous , Tinea , Upper ExtremityABSTRACT
Nodular syphilis is an uncommon manifestation of secondary syphilis and may appear on any area of the body, with the head and neck often affected. The lesions are generally red-brown or violaceous. Although the nodular lesions are said to be more common in tertiary syphilis, most recent reports have diagnosed them as a manifestation of secondary syphilis in patients who may also exhibit mild lymphadenopathy without associated constitutional symptoms. We report a case of nodular syphilid in a 43-year-old man who presented with numerous papular, nodular and plaque skin lesions, without involvement of the mucous membranes.
Subject(s)
Adult , Humans , Head , Lymphatic Diseases , Mucous Membrane , Neck , Skin , Syphilis , Syphilis, CutaneousABSTRACT
Nodular syphilis is an uncommon manifestation of secondary syphilis and may appear on any area of the body, with the head and neck often affected. The lesions are generally red-brown or violaceous. Although the nodular lesions are said to be more common in tertiary syphilis, most recent reports have diagnosed them as a manifestation of secondary syphilis in patients who may also exhibit mild lymphadenopathy without associated constitutional symptoms. We report a case of nodular syphilid in a 43-year-old man who presented with numerous papular, nodular and plaque skin lesions, without involvement of the mucous membranes.
Subject(s)
Adult , Humans , Head , Lymphatic Diseases , Mucous Membrane , Neck , Skin , Syphilis , Syphilis, CutaneousABSTRACT
The clinical feature of secondary syphilis is of `the great imitator'. The rarity of clinical syphilis today has led to an erosion of clinical skills to determine this condition. It is important for physicians to keep in mind that any atypical skin lesions may be syphilid. We report two cases of psoriasiform syphilid in a 64-year-old man and a 45-year-old woman. They presented with multiple, erythematous to brown colored scaly papules and plaques on the abdomen, back and chest. The differential diagnosis included papulosquamous diseases, especially psoriasis. Histopathologic findings were not consistent with that of psoriasis, but consisted rather with that of interface dermatitis. Serum VDRLs were strongly positive (1: 256 and 1: 64, respectively), and TPHAs were positive, too. After intramuscular treatment with 2.4 million units of benzathine penicillin G, the skin lesions cleared within 1 month.
Subject(s)
Female , Humans , Middle Aged , Abdomen , Clinical Competence , Dermatitis , Diagnosis, Differential , Penicillin G Benzathine , Psoriasis , Skin , Syphilis , Syphilis, Cutaneous , ThoraxABSTRACT
Psoriasiform lesion is rare in secondary syphilis. We report a case of psoriasiform syphilid in a 36-year-old man, who showed condyloma lata on the perianal area and multiple erythematous scaly plaques on the face, glans penis, scrotum, and both palms and soles. He had sexual contact with prostitute about 3 months ago. The differential diagnosis included papulosquamous diseases, especially psoriasis but a psoriasiform syphilid was confirmed through skin biopsies and serologic tests. The patient was treated with benzathine penicillin G 2.4 million units intramuscularly weekly for 3 weeks. After the treatment with benzathine penicillin G, the skin lesions disappeared completely.
Subject(s)
Adult , Humans , Male , Biopsy , Diagnosis, Differential , Penicillin G Benzathine , Penis , Psoriasis , Scrotum , Serologic Tests , Sex Workers , Skin , Syphilis , Syphilis, CutaneousABSTRACT
Psoriasiform lesion is a rare manifestation in secondary syphilis. A 34-year-old woman patient presented with a month history of condylomata lata on the perineum and erythematous scaling psoriasiform plaque on the back. The preliminary differential diagnosis included psoriasis and lichen simplex chronicus but a psoriasiform syphilid was confirmed through skin biopsies and serologic tests. We report a case of psoriasiform syphilid.
Subject(s)
Adult , Female , Humans , Biopsy , Diagnosis, Differential , Neurodermatitis , Perineum , Psoriasis , Serologic Tests , Skin , Syphilis , Syphilis, CutaneousABSTRACT
Nodular lesions, especially a solitary nodule, is a rare manifestation in secondary syphilis and a few cases have been described recently. The nodular syphilid needs to be differentiated from lymphoma and a granulomatous process. In a patient previously treated for malignancy, this nodular lesion could also be clinically misdiagnosed as cutaneous metastasis. We, herein, report a case of an unusual solitary noduiar syphilid mimicking cutaneous metastasis. A 57-year-old woman patient presented with a month history of an asymptomatic erythematous telangiectatic nodul on the nose tip. She was treated for malignant melanoma on the buttock 2 years previausly. The preliminary differential diagnosis included cutaneous metastasis and a granulomatous process, but a solitary nodular syphilid was confirmed through skin biopsies and serologic tests.
Subject(s)
Female , Humans , Middle Aged , Biopsy , Buttocks , Diagnosis, Differential , Lymphoma , Melanoma , Neoplasm Metastasis , Nose , Serologic Tests , Skin , Syphilis , Syphilis, CutaneousABSTRACT
The skin manifestations of secondary syphilis, termed syphilid, show macular, papular and papulosquamous rashes in most cases, but may show lots of other clinical findings. We report a case of syphitid simulating purpura annulsris telangieitodes in 25-year-old male who had a history of genital ulcer 2 months ago. The skin lesion showed diffuse erythematous, 1-3 cm sized, telangiectatic annular patchea and purpuric plaques on both lower extremities and discrete papulosquamous rashes on both soles. The results of the serologic test for syphili was found to be reactive to 32 dilution in serum VDRL test and positive in serum TPHA test. Histovathologically, we could observe the obscuring of dermoepidermal juction, coat-sleeve-like perivascular infiltrate composed of mononuclear cells and a few plasma cells, and endothelial swellings. Afte the treatment with benzathine penicillin G, the titer of serurn VDRL test was decreased abruptly to 4 dilution and the skin lesions disappeared completely.
Subject(s)
Adult , Humans , Male , Exanthema , Lower Extremity , Penicillin G Benzathine , Plasma Cells , Purpura , Serologic Tests , Skin , Skin Manifestations , Syphilis , Syphilis, Cutaneous , UlcerABSTRACT
BACKGROUND: The differentiation of syphilids from other skin decreases is frequently difficult due to considerable variations of clinical and histologic pattern. The most common histologic changes in secondary syphilis are swelling & proliferation of endothelial cells and the presence of a perivascular infiltrate containing plasmia cells. But often, these findings are absert or inconspicuous. OBJECTIVE: We examined the histopathologic findings of secondary syphilis in relation to the clinical types of the skin lesion. MEHTODS: 36 biopsy specimens from twenty-nine serologically and clinically confirmed cases of secondary syphilis (15 macules, 8 papules, 2 condylomata latas and 11 papulosquamous lesions) were examined. RESULTS: The histopath,ologic findings of secondary syphilis showed comparative differences according to the clinical types of the skin lesion. The plasms cell infltrates were absent or sparse in 14 csses(39%) and the plasma cell infiltration was significantly correhted with the age of skin lesions(p=0.02197). Vascular changes were seen in 32 cases (89%), but the incidence of endothelial proliferation was less(25%). CONCLUSION: This study demonstrates the histopathologic findirigs of secondary syphilis in accordance to the clinical morphology of the eruption and thus, help to differentiate syphilids from other skin diseases.
Subject(s)
Biopsy , Endothelial Cells , Incidence , Plasma Cells , Skin , Skin Diseases , Syphilis , Syphilis, CutaneousABSTRACT
Electron mlactimpic studies were performed on three primary and two early secondary syphilitic lesions from three patients. AZ of these patients had both secondary syphilitic lesions and chancres. There was no difference in the morphology and location of treponemes in these patients as compared to those who had only a chancre or only a syphilid reported earlier. This study revealed that Treponema pallida were principally located in the intercellular space of keratinocytes and exhacellular space of the dermis. Furthermore, these organisms were observed within histiocytes, endothelial cells, fibroblasts, lymphocytes and even plasma cells. The plasma cells had well developed endoplasmic reticulum, and in some, dilatation of the endoplasmic reticulum was noted. Many t mponemes were demonstrated in and around blood vessels. The vascular endothelial cells were proliferating and the basement membranes were thick.