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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

Partial regression of plaques one week after treatment
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Figure 4: Partial regression of plaques one week after treatment

Mentions: The patient received three weekly injections of 2.4 million units of intramuscular benzathine penicillin, along with 2 G of daily intravenous ceftriaxone for 15 days. He did not develop any fever after any of his injections (negative Jarisch-Herxheimer reaction). This treatment was followed by anti-retroviral therapy. The plaques on the back had flattened 50% within one week of the penicillin injection [Figure 4] and the eroded plaques on the forearm had regressed 70% by then. Within 20 days, the plaques had almost totally flattened, and 1½ months later, only hyperpigmented macules were remaining. After 4 months his repeat RPR had fallen to 1:64 dilution, and his CD4 count had risen to 547 cells/cmm. When last seen one year later, his RPR had further fallen to 1:16 dilution, and there was no recurrence of his skin lesions. He remained in good health.


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)

Partial regression of plaques one week after treatment
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Partial regression of plaques one week after treatment
Mentions: The patient received three weekly injections of 2.4 million units of intramuscular benzathine penicillin, along with 2 G of daily intravenous ceftriaxone for 15 days. He did not develop any fever after any of his injections (negative Jarisch-Herxheimer reaction). This treatment was followed by anti-retroviral therapy. The plaques on the back had flattened 50% within one week of the penicillin injection [Figure 4] and the eroded plaques on the forearm had regressed 70% by then. Within 20 days, the plaques had almost totally flattened, and 1½ months later, only hyperpigmented macules were remaining. After 4 months his repeat RPR had fallen to 1:64 dilution, and his CD4 count had risen to 547 cells/cmm. When last seen one year later, his RPR had further fallen to 1:16 dilution, and there was no recurrence of his skin lesions. He remained in good health.

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