Case report of three consecutive lues maligna infections in an HIV-infected patient

Sammet, Stefanie; Draenert, Rika

doi:10.1177/0956462416674102

Cited by 5 publications

(1 citation statement)

References 8 publications

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“…Again, this indicates an immunodeficiency apart from low CD4 count that predisposes to the development of UNRS. Sammet and Draenert reported an HIV patient who developed UNRS three consecutive times (likely re-infections) despite the start of antiretroviral therapy [ 34 ]. Likewise, Wang and coworkers reported an HIV patient who had two episodes of UNRS, separated by 13 months, despite receiving ART after the first episode [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

An Exuberant Case of Ulceronodular-Rupioid (Malignant) Syphilis in an HIV Patient: A Proposal for New Diagnostic Criteria

Jimenez,

Rabe,

Agarwal

et al. 2024

Infectious Disease Reports

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We report the case of a 28-year-old male with uncontrolled human immunodeficiency virus (HIV) infection who presented with extensive ulcerated lesions with dark lamellated crusting on his face, torso, and limbs. The patient had a rapid plasma reagin (RPR) titer of 1:512, indicative of syphilis. A skin biopsy revealed granulomata surrounded by lymphocytes, histiocytes, and plasma cells, with spirochetes visible on immunohistochemical staining. The patient’s rash resolved with hyperpigmented scarring after penicillin and doxycycline treatment. This severe form of secondary syphilis has been termed malignant syphilis, lues maligna, ulceronodular syphilis, or rupioid syphilis. We propose a single descriptive name for this entity, ulceronodular-rupioid syphilis. In 1969, Fisher proposed criteria for malignant syphilis based on lesion appearance, histopathologic findings, high RPR values, and rapid response to treatment. We found that the Fisher criteria were imprecise with respect to specific histopathologic findings, the quantitation of RPR values, and what constitutes rapid response to treatment. Thus, we examined an additional 74 cases from the literature and propose new diagnostic criteria based on rash appearance, histopathologic characteristics, non-treponemal and treponemal test positivity, and response to therapy. We also found that uncontrolled viremia, and not a low CD4 count, is a major risk factor for ulceronodular-rupioid syphilis in HIV patients.

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Section: Discussionmentioning

confidence: 99%

An Exuberant Case of Ulceronodular-Rupioid (Malignant) Syphilis in an HIV Patient: A Proposal for New Diagnostic Criteria

Jimenez,

Rabe,

Agarwal

et al. 2024

Infectious Disease Reports

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Syphilis

Hartrich¹,

Taira²

2018

Life-Threatening Rashes

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HIV-Related Skin Disease in the Era of Antiretroviral Therapy: Recognition and Management

et al. 2019

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Anti-retroviral therapy (ART) has revolutionized the treatment and prognosis of people living with HIV (PLHIV). With increased survival and improved overall health, PLHIV are experiencing dermatologic issues both specific to HIV and common to the general population. In this new era of ART, it is crucial for dermatologists to have a strong understanding of the broad range of cutaneous disease and treatment options in this unique population. In this review, we outline the most common skin diseases in PLHIV, including HIV-associated malignancies, inflammatory conditions, and infections, and focus on the role of ART in altering epidemiology, clinical features, diagnosis, and treatment of cutaneous conditions.

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Case report of three consecutive lues maligna infections in an HIV-infected patient

Cited by 5 publications

References 8 publications

An Exuberant Case of Ulceronodular-Rupioid (Malignant) Syphilis in an HIV Patient: A Proposal for New Diagnostic Criteria

An Exuberant Case of Ulceronodular-Rupioid (Malignant) Syphilis in an HIV Patient: A Proposal for New Diagnostic Criteria

Syphilis

HIV-Related Skin Disease in the Era of Antiretroviral Therapy: Recognition and Management

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