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A case of secondary syphilis with HIV, resembling borderline lepromatous leprosy.

Mani MZ, Kanish B, Kwatra K, Chaudhary PR, Bhatia A - Indian J Sex Transm Dis (2015 Jul-Dec)

Bottom Line: We are reporting an unusual case of secondary syphilis, in a homosexual male patient, which resembled borderline lepromatous leprosy, and in whom the diagnosis was considered on clinical grounds.The patient also had concomitant HIV infection, with asymptomatic neurosyphilis.He improved with three standard, weekly injections of benzathine penicillin, along with 2 g of intravenous ceftriaxone daily for 15 days.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and Venereology, Christian Medical College and Hospital, Ludhiana, Punjab, India.

ABSTRACT
We are reporting an unusual case of secondary syphilis, in a homosexual male patient, which resembled borderline lepromatous leprosy, and in whom the diagnosis was considered on clinical grounds. The patient also had concomitant HIV infection, with asymptomatic neurosyphilis. His rapid plasma reagin test was reactive in 1:128 dilution. He improved with three standard, weekly injections of benzathine penicillin, along with 2 g of intravenous ceftriaxone daily for 15 days. This case is being reported to highlight the need for a high index of suspicion in diagnosing unusual cases of secondary syphilis, especially in those with concomitant HIV infection.

No MeSH data available.


Related in: MedlinePlus

The eroded, annular plaques with scaly margins, on the right forearm, before treatment
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Figure 2: The eroded, annular plaques with scaly margins, on the right forearm, before treatment

Mentions: A 57 year old middle class male patient presented with asymptomatic, generalized, annular plaques present for 2½ months, and without constitutional symptoms. He had consulted various doctors, but without relief. A skin biopsy performed outside was reported as tuberculoid leprosy. The plaques were situated on the front and back of trunk [Figure 1], on the upper extremities and thighs, and on the face, with confluent nodules on the forehead. The larger plaques were 4-5 cm in size, and had succulent papulonodules at the margin [Figure 1, site of biopsy 1]. Other plaques had scaly margins, which were rolled out [Figure 1]. On the right forearm there were eroded, annular plaques, with sharply raised overhanging, and scaly margins [Figure 2]. The differential diagnosis included sarcoidosis and mycosis fungoides, besides BL leprosy. However, on noting that the plaques showed increased sensitivity to pain (Buschke-Ollendorf sign), secondary syphilis was also considered. Moreover, a generalized and epitrochlear lymphadenopathy was also noted, but there were no mucous patches or condyloma lata.


A case of secondary syphilis with HIV, resembling borderline lepromatous leprosy.

Mani MZ, Kanish B, Kwatra K, Chaudhary PR, Bhatia A - Indian J Sex Transm Dis (2015 Jul-Dec)

The eroded, annular plaques with scaly margins, on the right forearm, before treatment
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660561&req=5

Figure 2: The eroded, annular plaques with scaly margins, on the right forearm, before treatment
Mentions: A 57 year old middle class male patient presented with asymptomatic, generalized, annular plaques present for 2½ months, and without constitutional symptoms. He had consulted various doctors, but without relief. A skin biopsy performed outside was reported as tuberculoid leprosy. The plaques were situated on the front and back of trunk [Figure 1], on the upper extremities and thighs, and on the face, with confluent nodules on the forehead. The larger plaques were 4-5 cm in size, and had succulent papulonodules at the margin [Figure 1, site of biopsy 1]. Other plaques had scaly margins, which were rolled out [Figure 1]. On the right forearm there were eroded, annular plaques, with sharply raised overhanging, and scaly margins [Figure 2]. The differential diagnosis included sarcoidosis and mycosis fungoides, besides BL leprosy. However, on noting that the plaques showed increased sensitivity to pain (Buschke-Ollendorf sign), secondary syphilis was also considered. Moreover, a generalized and epitrochlear lymphadenopathy was also noted, but there were no mucous patches or condyloma lata.

Bottom Line: We are reporting an unusual case of secondary syphilis, in a homosexual male patient, which resembled borderline lepromatous leprosy, and in whom the diagnosis was considered on clinical grounds.The patient also had concomitant HIV infection, with asymptomatic neurosyphilis.He improved with three standard, weekly injections of benzathine penicillin, along with 2 g of intravenous ceftriaxone daily for 15 days.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and Venereology, Christian Medical College and Hospital, Ludhiana, Punjab, India.

ABSTRACT
We are reporting an unusual case of secondary syphilis, in a homosexual male patient, which resembled borderline lepromatous leprosy, and in whom the diagnosis was considered on clinical grounds. The patient also had concomitant HIV infection, with asymptomatic neurosyphilis. His rapid plasma reagin test was reactive in 1:128 dilution. He improved with three standard, weekly injections of benzathine penicillin, along with 2 g of intravenous ceftriaxone daily for 15 days. This case is being reported to highlight the need for a high index of suspicion in diagnosing unusual cases of secondary syphilis, especially in those with concomitant HIV infection.

No MeSH data available.


Related in: MedlinePlus