Sífilis maligna: comunicación de 2 casos en pacientes sin SIDA / Malignant syphilis: report of 2 cases in patients without AIDS

La sífilis es una enfermedad polifacética que siempre requiere diagnósticos diferenciales. Una forma rara de la sífilis secundaria, es la llamada sífilis maligna caracterizada por lesiones ulcero necróticas cubiertas por gruesas costras de aspecto rupioide u ostráceo. Actualmente se observa principalmente en pacientes infectados por el virus de la inmunodeficiencia humana, pero anteriormente ya fue descrita en otras situaciones debilitantes como el alcoholismo, desnutrición, diabetes etc. Eventualmente puede verse en pacientes inmunocompetentes como los 2 casos que presentamos.

Syphilis is a multifaceted disease that always requires differential diagnoses. A rare form of secondary syphilis is the so-called malignant syphilis characterized by necrotic ulcerated lesions covered by thick crusts with a rupioid or ostraceous appearance. Currently observed mainly in patients infected with the human immunodeficiency virus, but it was previously described in other debilitating situations such as alcoholism, y malnutrition. Eventually it can be seen in immunocompetent patients like the 2 cases we present.

Sífilis maligna en paciente con infección por el virus de la inmunodeficiencia humana / Malignant syphilis in a patient with HIV infection

Resumen La sífilis maligna asociada al virus de la inmunodeficiencia humana (HIV). Se presenta con lesiones nodulares cutáneas con tendencia a la ulceración. Entre sus hallazgos histopatológicos se destaca la presencia de granulomas no caseificantes, lo cual obliga al diagnóstico diferencial con otras patologías granulomatosas infecciosas y no infecciosas. La evolución de la enfermedad es favorable con el tratamiento con penicilina en la mayoría de los casos. Presentamos el caso de una paciente con infección por HIV que cumple criterios diagnósticos de sífilis maligna y alertamos sobre esta entidad granulomatosa poco frecuente.

Abstract 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 HIV Seropositive Man / 대한피부과학회지

No abstract available.

Sífilis secundaria maligna, forma clínica rupioide, en una enferma VIH positiva. Rara presentación de la lúes secundaria: Presentación de un caso y revisión de la literatura / Malignant secondary syphilis, rupioid clinical form, in a female HIV - seropositive: Report of a case and literature review

La sífilis maligna es una forma infrecuente de presentación de la sífilis secundaria, generalmente asociada a la infección por el virus de la inmunodeficiencia humana (VIH). Una forma rara de presentación es la sífilis rupioide, caracterizada por lesiones múltiples, ulcerativas, que se cubren de escamas que le dan un aspecto rupioide (rupia sifilítica) y se acompañan de manifestaciones clínicas sistémicas. Se presenta una paciente VIH seropositiva, que desarrolló una sífilis secundaria maligna, con lesiones rupioides y manifestaciones de compromiso sistémico, respondiendo favorablemente al tratamiento con penicilina benzatínica.

Malignant syphilis is a rare form of secondary syphilis strongly associated with human immunodeficiency virus infection (HIV). A rare clinical form of presentation include multiple, large and rupia-like ulcerative lesions associated with systemic clinical manifestations. Here we describe an HIV-seropositive female who developed clinical cutaneous and systemic manifestations of malignant rupioid syphilis, with a good response to treatment with benzatin penicillin and we performed a review of the literature.

Sífilis maligna precoz asociada a VIH / Early malignant syphilis associated with HIV

La sífilis maligna precoz es una manifestación peculiar del período secundario caracterizado por lesiones papulosas y costrosasde carácter mutilante. Presentamos una paciente de 20 años VIH positivo, con lesiones papulosas y úlceras cubiertas por costras rupioides localizadas en cara, tronco, extremidades y región genital, respetando mucosa oral. Motiva esta comunicación la importancia del reconocimiento de esta forma clínica y su asociación con cuadros de inmunosupresión.

Early malignant syphilis is a peculiar manifestation of the secondary period characterized by crusted papules with mutilatingbehaviour. We report an HIV positive 20-year-old patient presenting papular lesions and ulcers covered by rupioid crusts locatedon face, trunk, limbs and genital region. Oral mucosa wasn´t involved. We emphasize the importance of recognition of this clinicalform and its association with immunosuppression states.

Sífilis maligna en un paciente con infección por VIH: Presentación de un caso y revisión de la literatura / Malignant syphilis in a patient infected by human immunodeficiency virus: Case report and literature review

Malignant syphilis is a rare form of secondary syphilis strongly associated with human immunodeficiency virus infection (HIV). This clinical form of the disease is characterized by atypical cutaneous ulcerative and disseminated lesions and systemic compromise that can delay the final diagnosis. There are only few reports in the medical literature about malignant lues in HIV-infected patients. Malignant syphilis should be considered in the differential diagnosis in HIV-infected patients with fever and ulcerative skin lesions. Here we describe a man who developed clinical cutaneous and systemic manifestations pathologically conirmed as malignant syphilis and we performed a review of the literature.

La sífilis maligna es una forma rara de presentación de lúes secundaria asociada a la infección por el virus de la inmunodeficiencia humana (VIH). Se caracteriza por lesiones cutáneas atípicas, ulceradas, costrosas y diseminadas, asociadas con síntomas generales inespecíficos que pueden retrasar el diagnóstico correcto. Existen sólo escasas publicaciones en la literatura médica acerca de sífilis maligna en pacientes con infección por VIH. La lúes maligna debe incluirse en el diagnóstico diferencial de los pacientes con VIH que consultan por fiebre y lesiones úlcero-costrosas diseminadas. Se describe el caso de un paciente con infección por VIH que desarrolló una sífilis maligna con confirmación diagnóstica a partir de los hallazgos histopatológicos y se realiza una revisión de la literatura científica sobre el tema.

Conventional systemic treatments associated with therapeutic sites of local lesions of secondary syphilis in the oral cavity in patients with AIDS.

Patients with HIV infection may develop common diseases with atypical clinical features. HIV infection can change the classic clinical course of syphilis and increase the incidence of malignant syphilis. Malignant syphilis is a rare subtype of secondary syphilis that presents special clinical and histological features and has been associated with several processes characterized by variable degrees of immunosuppression. It is necessary to consider the possibility of this entity in the differential diagnoses in HIV-infected patients with cutaneous lesions. The dental surgeon (or oral surgeon) is vital to the medical team for promoting the health and improving the quality of life of syphilis patients. A patient with HIV infection was referred to us for complaints of a white patch on the tongue, stinging and burning sensation on the tongue, loss of taste, and dryness of the mouth. On clinical examination, the patient was found to have a tabetic gait (the Prussian soldier gait) associated with Charcot arthropathy. We also identified bilateral lesions with ulceration and exposure of the tissue that were tender, characterized by discrete necrosis. The treatment that was initiated at that time involved cleaning the area with gauze to remove all the white patches, followed by rinsing with bicarbonate in water (one teaspoon of baking soda dissolved in half a glass of water) four times a day. Additionally, fluconazole (100 mg/day for 7 days) was prescribed. We diagnosed secondary malignant syphilis of approximately 5 days duration. As an adjunctive therapy, we performed low-intensity laser treatment using a GaAsAl (gallium-aluminum arsenide) laser at 790 nm. With this treatment there was progressive resolution of the lesions.

Malignant Syphilis in an Acquired Immune Deficiency Syndrome Patient / 대한피부과학회지

Malignant syphilis (also known as lues maligna) is a rare dermatologic manifestation of syphilis and this is more commonly seen in patients with human immunodeficiency virus (HIV) infection. A 40-year-old man presented with general malaise and widespread cutaneous noduloulcerative lesions covered with lamellar crusts for 15 days. He had been diagnosed with HIV infection 6 years earlier, but had not regularly taken antiretroviral drugs. The syphilis serology showed a VDRL (venereal disease research laboratory) titer of 1 : 256 and a positive TPPA (treponema pallidum particle agglutination test) at presentation. Histologic exam showed the dense perivascular inflammatory infiltrates composed of lymphocytes, histiocysts and neurophils with some plasma cells in the underlying upper and reticular dermis. Obliterated blood vessels with eosinophilic materials were observed as an unusual histologic feature of syphilis. Based on the clinical, histological and serological findings, a diagnosis of malignant syphilis accompanied by acquired immune deficiency syndrome (AIDS) was made. The patient was treated with intramuscular benzathine penicillin G at 2.4 million units per week for 3 weeks, and the skin lesions completely healed with post-inflammatory hyperpigmentation. It is necessary to take into account this entity among the possible diagnoses in HIV-infected patients with cutaneous noduloulcerative lesions.