A case of primary and secondary syphilis presenting together as immune reconstitution inflammatory syndrome

Abstract

Immune reconstitution inflammatory syndrome (IRIS) is a condition during the clinical course of HIV infection in which there is paradoxical worsening and/or new onset of opportunistic infections in a HIV-positive patient who has recently been started on anti-retroviral therapy (ART). We present a case of AIDS with CD4 count of 20 cells/μl who presented within 6 weeks of starting ART with a CD4 count of 160 cells/μl and a painless solitary genital ulcer along with annular dark-colored plaques over soles. His screening test for syphilis was negative both during baseline evaluation, prior to initiation of ART, and during his clinical presentation. His disease was confirmed based on a positive treponema pallidum hemagglutination test report and a suggestive skin biopsy. He responded well to three doses of Benzathine Penicillin and continuation of ART. There are very few case reports of syphilis presenting as IRIS and this case is all the more unique as he had features of both primary and secondary syphilis occurring together within 6 weeks of starting ART. This report would reiterate the fact that syphilis and HIV co-infection can alter the natural course of both the diseases and a high index of suspicion is required for treating them.

A case of syphilis associated with immune reconstitution inflammatory syndrome and review of the literature

“…It is plausible that the restoration of immune responses as a result of effective HIV-1 treatment triggers the unmasking of subclinical Treponema pallidum infection and subsequent seroconversion. On the other hand, a negative syphilis serology could be caused by the prozone phenomenon or the hook effect, in which an overabundance of an antigen led to a false-negative result [3,[8][9][10]. Treatment for IRIS syphilis does not differ from standard syphilis therapy, and steroid therapy would seem unnecessary.…”

“…The de nition of IRIS-syphilis is complex as it is not always possible to discern it from a recent infection or a worsening of an undiagnosed one. Syphilis syndromes have rarely been described in the context of immune reconstitution, and only a few cases have been reported in the literature [3]. A computerized search was performed without language restriction using PubMed, SCOPUS and Web of Science™ for all cases of IRIS-syphilis from database inception until April 2022.…”

“…"Unmasking IRIS" is de ned as a new appearance of symptoms related to an unknown infection, and "paradoxical IRIS" is de ned as the worsening of a previously noted [2]. IRIS has rarely been reported in the context of syphilis infection [3].…”

A Case of Secondary Syphilis with the Extragenital Chancre of the Lips and Tongue

“…Similar reports are common at home and abroad. 6 Based on the history and signs, his tongue lesions could be defined as kissing chancre, it may also be related to self-inoculation. 7 …”

Letter in response to “A case of primary and secondary syphilis presenting together as immune reconstitution inflammatory syndrome”

“…We read with interest the article entitled “A case of primary and secondary syphilis presenting together as immune reconstitution inflammatory syndrome (IRIS)” by Mitra et al . [ 1 ] The authors have presented the simultaneous occurrence of primary and secondary syphilis in a human immunodeficiency virus (HIV)-positive patient on antiretroviral therapy (ART) labeling this event as a part of IRIS.…”