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Malignant syphilis in an immunocompetent female patient.

Requena CB, Orasmo CR, Ocanha JP, Barraviera SR, Marques ME, Marques SA - An Bras Dermatol (2014 Nov-Dec)

Bottom Line: Malignant syphilis is an uncommon manifestation of secondary syphilis, in which necrotic lesions may be associated with systemic signs and symptoms.Generally it occurs in an immunosuppressed patient, mainly HIV-infected, but might be observed on those who have normal immune response.We report a case in an immunocompetent female patient.

View Article: PubMed Central - PubMed

Affiliation: Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp), Botucatu, SP, Brazil.

ABSTRACT
Malignant syphilis is an uncommon manifestation of secondary syphilis, in which necrotic lesions may be associated with systemic signs and symptoms. Generally it occurs in an immunosuppressed patient, mainly HIV-infected, but might be observed on those who have normal immune response. Since there is an exponential increase in the number of syphilis cases, more diagnoses of malignant syphilis must be expected. We report a case in an immunocompetent female patient.

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Malignant syphilis: ulcerated lesion with superficial crust and dense lichenoidlymphohistiocytic infiltrate, rich in plasmocytes. HE 10X
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f04: Malignant syphilis: ulcerated lesion with superficial crust and dense lichenoidlymphohistiocytic infiltrate, rich in plasmocytes. HE 10X

Mentions: A female patient, 29 years old, presented with a two weeks history of aclinical-dermatological picture characterized by the presence of fever, loss of appetiteand myalgia, soon followed by the onset of skin lesions like pustules and nodules thatprogressed to ulcers. Except for psoriasis, she did not present other comorbidities. Thephysical examination showed that the patient was in apparent satisfactory generalcondition, afebrile and with multiple lesions as nodules, ulcerated nodules and ulcers,the latter with a necrotic aspect, sometimes covered by scabs. The lesions were mainlylocated on the face, thorax and upper limbs (Figures1, 2 and 3). The palms had sparse lesions of small diameter, erythematous, discreetlyinfiltrated and with a collarette of scales surrounding them. There were no lesions onoral or genital mucosa, but in the perianal region and along the intergluteal cleft asingle, longitudinal ulcerated papulonodular lesion could be observed, compatible with acondiloma lata lesion. The ophthalmological and neurological examination did not revealabnormalities. Serum investigation showed VDRL = 1/256, positive treponemal test andnegative serology for HIV, VHB and VHC infection. The histopathological examination ofone of the lesions showed epidermal ulceration, presence of hematic crust and denselichenoid lymphohistiocytic infiltrate rich in plasmocytes, which extended until thedeep dermis. The vessels presented endothelial tumefaction with walls permeated bypolymor-phonuclear cells and fibrin microthrombi. Anti-Treponemapallidum immunomarking with polyclonal antibody was positive, evidencingnumerous spirochetes (Figures 4, 5 and 6).


Malignant syphilis in an immunocompetent female patient.

Requena CB, Orasmo CR, Ocanha JP, Barraviera SR, Marques ME, Marques SA - An Bras Dermatol (2014 Nov-Dec)

Malignant syphilis: ulcerated lesion with superficial crust and dense lichenoidlymphohistiocytic infiltrate, rich in plasmocytes. HE 10X
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4230668&req=5

f04: Malignant syphilis: ulcerated lesion with superficial crust and dense lichenoidlymphohistiocytic infiltrate, rich in plasmocytes. HE 10X
Mentions: A female patient, 29 years old, presented with a two weeks history of aclinical-dermatological picture characterized by the presence of fever, loss of appetiteand myalgia, soon followed by the onset of skin lesions like pustules and nodules thatprogressed to ulcers. Except for psoriasis, she did not present other comorbidities. Thephysical examination showed that the patient was in apparent satisfactory generalcondition, afebrile and with multiple lesions as nodules, ulcerated nodules and ulcers,the latter with a necrotic aspect, sometimes covered by scabs. The lesions were mainlylocated on the face, thorax and upper limbs (Figures1, 2 and 3). The palms had sparse lesions of small diameter, erythematous, discreetlyinfiltrated and with a collarette of scales surrounding them. There were no lesions onoral or genital mucosa, but in the perianal region and along the intergluteal cleft asingle, longitudinal ulcerated papulonodular lesion could be observed, compatible with acondiloma lata lesion. The ophthalmological and neurological examination did not revealabnormalities. Serum investigation showed VDRL = 1/256, positive treponemal test andnegative serology for HIV, VHB and VHC infection. The histopathological examination ofone of the lesions showed epidermal ulceration, presence of hematic crust and denselichenoid lymphohistiocytic infiltrate rich in plasmocytes, which extended until thedeep dermis. The vessels presented endothelial tumefaction with walls permeated bypolymor-phonuclear cells and fibrin microthrombi. Anti-Treponemapallidum immunomarking with polyclonal antibody was positive, evidencingnumerous spirochetes (Figures 4, 5 and 6).

Bottom Line: Malignant syphilis is an uncommon manifestation of secondary syphilis, in which necrotic lesions may be associated with systemic signs and symptoms.Generally it occurs in an immunosuppressed patient, mainly HIV-infected, but might be observed on those who have normal immune response.We report a case in an immunocompetent female patient.

View Article: PubMed Central - PubMed

Affiliation: Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp), Botucatu, SP, Brazil.

ABSTRACT
Malignant syphilis is an uncommon manifestation of secondary syphilis, in which necrotic lesions may be associated with systemic signs and symptoms. Generally it occurs in an immunosuppressed patient, mainly HIV-infected, but might be observed on those who have normal immune response. Since there is an exponential increase in the number of syphilis cases, more diagnoses of malignant syphilis must be expected. We report a case in an immunocompetent female patient.

Show MeSH
Related in: MedlinePlus