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Annular lichenoid syphilis: A rare entity.

Khurana A, Singal A, Gupta S - Indian J Sex Transm Dis (2014 Jul-Dec)

Bottom Line: Syphilis is a disease known for centuries, but still continues to be a diagnostic challenge as the myriad manifestations of secondary syphilis can mimic a lot many dermatological disorders.Lichenoid syphilis is an uncommon entity, reported only occasionally in the penicillin era.We present the case of a 32-year-old woman presenting with localized annular lichenoid lesions on the neck.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital (University of Delhi), New Delhi, India.

ABSTRACT
Syphilis is a disease known for centuries, but still continues to be a diagnostic challenge as the myriad manifestations of secondary syphilis can mimic a lot many dermatological disorders. Lichenoid syphilis is an uncommon entity, reported only occasionally in the penicillin era. We present the case of a 32-year-old woman presenting with localized annular lichenoid lesions on the neck.

No MeSH data available.


Related in: MedlinePlus

Annular lichenoid plaques on the nape of neck (a) subsiding completely 2 weeks posttreatment (b). Condyloma lata involving groins, labia majora and pubic region (c) with complete resolution post injection penicillin (d)
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Figure 1: Annular lichenoid plaques on the nape of neck (a) subsiding completely 2 weeks posttreatment (b). Condyloma lata involving groins, labia majora and pubic region (c) with complete resolution post injection penicillin (d)

Mentions: A 32-year-old married woman presented with complaints of itchy red rash on her forearms and nape of neck for 2 months. She was clinically diagnosed as polymorphic light eruption and started on mild potent topical corticosteroids and antihistaminics, along with instructions for strict photo protection and use of sunscreen. Her forearm lesions improved with this treatment, but lesions on the nape of neck had worsened with complaints of significant itching, when the patient came for follow-up 2 weeks later. Clinical examination at this point of time revealed presence of annular lichenoid plaques and few lichenoid papules [Figure 1a]. Mucosal examination revealed no abnormality. A skin biopsy was ordered from the lesion on the nape of neck, keeping differentials of annular lichen planus and sarcoidosis. The biopsy revealed acanthosis, and hyperkeratosis in the epidermis. A focal interface infiltrate composed of lymphocytes with a conspicuous presence of the plasma cells as well as eosinophils was seen within the dermis [Figure 2a]. There was also prominent endothelial inflammation with endothelial cell swelling and red blood cell extravasation [Figure 2b]. At places, complete obliteration of the vascular lumina (endarteritis obliterans) was seen, with presence of plasma cells in the vessel walls [Figure 2b]. Based on these findings, a possibility of syphilis was suggested by the pathologist. About a week later, patient reported to us with new lesions over her genitalia and groin. Examination revealed multiple skin coloured to pinkish, flat topped, moist appearing papules in the perianal region, labia majora, pubic region and groin folds, suggestive of condyloma lata [Figure 1c]. In addition, she had developed multiple hyperpigmented macules on both palms. Other mucosae were not involved. There was no evidence of generalized lymphadenopathy or hepatosplenomegaly. Husband was also examined but had no clinical evidence of syphilis. Dark ground illumination test performed from the wet lesions of condyloma lata revealed spiral spirochetes with characteristic motility. Venereal disease research laboratory assay came out to be positive in the titres of 1:256 for the patient and in 1:8 for her husband. Thus, a diagnosis of secondary syphilis (S2) was established. Both partners also had a positive treponema pallidum hemagglutination test. Serology for HIV and hepatitis B was negative in both. Repeated questioning about the possible source of infection was not rewarding. Both patient and her husband were treated with a single shot of 2.4 million units of benzathine penicillin after sensitivity testing. All lesions in patient resolved completely within a span of 2 weeks [Figure 1b and d].


Annular lichenoid syphilis: A rare entity.

Khurana A, Singal A, Gupta S - Indian J Sex Transm Dis (2014 Jul-Dec)

Annular lichenoid plaques on the nape of neck (a) subsiding completely 2 weeks posttreatment (b). Condyloma lata involving groins, labia majora and pubic region (c) with complete resolution post injection penicillin (d)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553845&req=5

Figure 1: Annular lichenoid plaques on the nape of neck (a) subsiding completely 2 weeks posttreatment (b). Condyloma lata involving groins, labia majora and pubic region (c) with complete resolution post injection penicillin (d)
Mentions: A 32-year-old married woman presented with complaints of itchy red rash on her forearms and nape of neck for 2 months. She was clinically diagnosed as polymorphic light eruption and started on mild potent topical corticosteroids and antihistaminics, along with instructions for strict photo protection and use of sunscreen. Her forearm lesions improved with this treatment, but lesions on the nape of neck had worsened with complaints of significant itching, when the patient came for follow-up 2 weeks later. Clinical examination at this point of time revealed presence of annular lichenoid plaques and few lichenoid papules [Figure 1a]. Mucosal examination revealed no abnormality. A skin biopsy was ordered from the lesion on the nape of neck, keeping differentials of annular lichen planus and sarcoidosis. The biopsy revealed acanthosis, and hyperkeratosis in the epidermis. A focal interface infiltrate composed of lymphocytes with a conspicuous presence of the plasma cells as well as eosinophils was seen within the dermis [Figure 2a]. There was also prominent endothelial inflammation with endothelial cell swelling and red blood cell extravasation [Figure 2b]. At places, complete obliteration of the vascular lumina (endarteritis obliterans) was seen, with presence of plasma cells in the vessel walls [Figure 2b]. Based on these findings, a possibility of syphilis was suggested by the pathologist. About a week later, patient reported to us with new lesions over her genitalia and groin. Examination revealed multiple skin coloured to pinkish, flat topped, moist appearing papules in the perianal region, labia majora, pubic region and groin folds, suggestive of condyloma lata [Figure 1c]. In addition, she had developed multiple hyperpigmented macules on both palms. Other mucosae were not involved. There was no evidence of generalized lymphadenopathy or hepatosplenomegaly. Husband was also examined but had no clinical evidence of syphilis. Dark ground illumination test performed from the wet lesions of condyloma lata revealed spiral spirochetes with characteristic motility. Venereal disease research laboratory assay came out to be positive in the titres of 1:256 for the patient and in 1:8 for her husband. Thus, a diagnosis of secondary syphilis (S2) was established. Both partners also had a positive treponema pallidum hemagglutination test. Serology for HIV and hepatitis B was negative in both. Repeated questioning about the possible source of infection was not rewarding. Both patient and her husband were treated with a single shot of 2.4 million units of benzathine penicillin after sensitivity testing. All lesions in patient resolved completely within a span of 2 weeks [Figure 1b and d].

Bottom Line: Syphilis is a disease known for centuries, but still continues to be a diagnostic challenge as the myriad manifestations of secondary syphilis can mimic a lot many dermatological disorders.Lichenoid syphilis is an uncommon entity, reported only occasionally in the penicillin era.We present the case of a 32-year-old woman presenting with localized annular lichenoid lesions on the neck.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital (University of Delhi), New Delhi, India.

ABSTRACT
Syphilis is a disease known for centuries, but still continues to be a diagnostic challenge as the myriad manifestations of secondary syphilis can mimic a lot many dermatological disorders. Lichenoid syphilis is an uncommon entity, reported only occasionally in the penicillin era. We present the case of a 32-year-old woman presenting with localized annular lichenoid lesions on the neck.

No MeSH data available.


Related in: MedlinePlus