Malignant syphilis: a new and revised definition

Abstract

Malignant syphilis is a rare, severe variant of secondary syphilis that primarily affects immunocompromised patients. Historically, the clinical presentation included a prodrome of constitutional symptoms followed by the development of characteristic skin lesions. The definition of malignant syphilis has not been updated since it was first described as only a cutaneous manifestation. In recent years, syphilis has reemerged as a major public health issue, particularly in men who have sex with men (MSM) and patients with HIV. With increasing rates of syphilis in the HIV‐positive population, the systemic manifestations of malignant syphilis have become more apparent. We propose a revised definition and elucidate why the term malignant syphilis should be expanded to include systemic manifestations, stressing musculoskeletal, central nervous system, ocular, ear, cardiovascular, rectal, liver, lung, and renal involvement. This updated definition is dramatically expanded to reflect its systemic manifestations. Recognition of these manifestations may prevent devastating long‐term effects.

Atypical Manifestations of Syphilis: A 10-Year Retrospective Study

“…Several pathogenetic theories have been postulated to explain its development. First, it could be related to an abnormally elevated immune response: studies of malignant syphilis tissues have demonstrated very few organisms and an excessive inflammatory infiltrate; secondly, interaction with HIV or another cause of immunosuppression may result in this particular aspect; the last theory suggests that malignant syphilis results from strains of T. pallidum with increased virulence [ 60 , 61 ]. Interestingly, the fact that most HIV-seropositive patients with malignant syphilis do not have a severely decreased CD4+ count may suggest that the pathogenesis of malignant syphilis is not related to a quantitative deficit in the immune system but rather to a qualitative immune dysfunction [ 60 ].…”

Painful Palmoplantar Lesions Following Vaccination: Answer

“…6 Histology is highly variable, equivalent to classic secondary syphilis, but leukocytoclastic vasculitis is practically a constant finding. 7 There are no pathognomonic features unless Treponema pallidum is demonstrated by immunohistochemistry. Similar to LyP, an interstitial infiltrate of atypical CD30-positive lymphocytes and plasma cells can be observed.…”

Severe Cutaneous Manifestation of Malignant Syphilis in a Patient with Behçet’s Uveitis: A case report

“…This group includes patients with conditions such as HIV, alcoholism, malnutrition, diabetes mellitus, or those receiving immunosuppressive therapy. [5] Skin lesions in malignant syphilis were described as nodules with central necrotic ulcers, sometimes accompanied by rupioid crusting. [5][6][7] Given the ongoing increase in syphilis infections among immunosuppressed individuals, recognizing these atypical cutaneous manifestations becomes a diagnostic challenge.…”