Osteolytic lesions in secondary syphilis.

A 37-year-old man was admitted with bone pain, night sweats, and skin lesions typical of secondary syphilis. His VDRL and FTA-ABS tests were reactive. Roentgenograms of the tibiae, fibulae, radii, and ulnae showed osteolytic lesions. A tibial biopsy examination showed bone necrosis, prominent vascularity, swollen endothelial cells, an intense plasma cell infiltrate, and numerous spirochetes. All manifestations responded to penicillin therapy. There have been few reports of osteolytic lesions in secondary syphilis. This is the first known case in which such involvement was unequivocally proven by histopathology with the demonstration of spirochetes.

New look at pyoderma gangrenosum.

Pyoderma gangrenosum cannot be viewed simply as "an ulcer with undermined bluish borders," since this description recognizes only one stage of the evolving process. Patients with this disorder often have cutaneous lesions including papules, pustules, and plaques that evolve and resolve without ever passing through an ulcerative stage. Moreover, such patients frequently have a variety of internal inflammatory and ulcerative disorders. The nature of these disorders as well as the increasing evidence of grossly altered immunity in pyoderma gangrenosum is also presented.

Borderline and reactive FTA-ABS. Results in lupus erythematosus.

Fluorescent treponemal antibody absorption tests were performed on serum samples from 43 patients with lupus erythematosus (LE). Seven borderline and three reactive results were obtained from patients who had no evidence of syphilis, and Treponema pallidum immobilization (TPI) tests were nonreactive. These probable nonsyphilitic reactions were associated with discoid LE (DLE) as frequently as with systemic LE (SLE). Three of these serum samples were reactive in the microhemagglutination assay for T pallidum antibodies (MHA-TP), but titers were low. Reactive FTA-ABS tests were also obtained from four patients with LE with evidence of syphilis. All four serum samples were highly reactive in the MHA-TP test. These findings suggest that nonsyphilitic FTA-ABS fluorescence is (1) common with both DLE and SLE, (2) frequently not "beaded" in pattern, and (3) often detectable when MHA-TP tests are performed.

Lupus erythematosus and reactive tests for syphilis: update.

Sera of patients with lupus erythematosus can produce false-positive reactions in most serologic tests for syphilis, including the FTA-ABS test. False-positive reactions in the FTA-ABS test can exhibit beaded, borderline or reactive patterns of fluorescence. Beaded fluorescence is commonly associated with anti-DNA antibody and other correlates of lupus activity. Borderline and reactive results are common in both systemic and discoid lupus erythematosus, and are usually not associated with increased clinical activity. TPI and MHA-TP tests appear helpful in detecting false-positive FTA-ABS results.

Generalized exfoliative dermatitis from ethylenediamine.

A patient with a history of allergic reaction to an antibiotic cream (Mycolog [mixture of nystatin, neomycin sulfate, gramicidin, and triamcinolone acetonide]) was treated with aminophylline. A generalized exfoliative dermatitis resulted. The reaction was attributable to ethylenediamine hydrochloride, which is a component of both agents. Recognition of the potential for systemic medications to induce similar reactions in patients who are allergic to related topical preparations is important when prescribing systemic agents.

Chronic urticaria from isophane insulin therapy; sensitivity associated with noninsulin components in commercial preparations.

A young woman with diabetes mellitus developed chronic urticaria after changing from isophane been insulin suspension to isophane beef-pork insulin suspension. She reverted to treatment with her original insulin preparation, but urticaria failed to terminate. While in the hospital, her eruption began each afternoon at the site of insulin injection. Zinc single-peak beef insulin suspension, a purer preparation with different additives than isophane beef insulin, was substituted, and urticaria terminated rapidly. Intradermal skin testing using single-peak (purified) preparations indicated that the patient was sensitive to beef and pork forms of isophane insulin but not to beef and pork forms of zinc insulin. The patient later had a brief recurrence of urticaria following oral erythromycin and tetracycline therapy but did not develop lesions at sites of insulin injection.