Malignant Syphilis in a Female Patient: A Case Report and Mini-Review

Abstract

Malignant syphilis (MS) is a rare form of secondary syphilis with grotesque skin lesions, systemic manifestation and life-threatening complications. This article presents a case of MS in an immunocompetent 41-year-old female, who initially manifested with a generalized nonpruritic erythematous rash and systemic symptoms. She was mistreated for generalized impetigo and hepatitis attributed to chronic alcoholism. After partial recovery and a 3-month latent period, she developed infiltrated plaques with crusts on the trunk, head and neck; pharyngitis and laryngeal lesions; generalized lymphadenopathy and nonspecific systemic symptoms. Serologic tests confirmed syphilis, and cerebrospinal fluid analyses indicated the presence of anti-treponemal antibodies. Urine drug screening was positive for cannabinoids. The polymerase chain reaction from skin biopsy samples identified T. pallidum, confirmed with Warthin–Starry staining. Immunohistochemical analysis was uncharacteristic. Tertiary syphilis, neurosyphilis, ocular syphilis and otosyphilis were excluded. However, the patient was treated for neurosyphilis with benzylpenicillin (18 million IU intravenously daily, 14 days) and corticosteroids. No Jarisch–Herxheimer reaction occurred. Ten months after treatment, residual scars were visible, and 1 year later, she attempted suicide. Since MS can resemble other diseases, it should be suspected in a mentally ill patient with chronic drug abuse, systemic nonspecific manifestations and dermatological abnormalities, including the head and neck region.

Malignant syphilis in a young woman: A case report

“… 11 In addition, MS typically involves the trunk and extremities, 11 but barely the head and neck. 12 Associated systemic symptoms are common, such as fever and arthralgia, myalgia, headache and photophobia. 8 …”

“…11 In addition, MS typically involves the trunk and extremities, 11 but barely the head and neck. 12 Associated systemic symptoms are common, such as fever and arthralgia, myalgia, headache and photophobia. 8 This current patient was diagnosed as having MS based on the following diagnostic criteria: 13 (i) explosive generalized lesions distribution; (ii) extremely high TRUST titre and the confirmed presence of T. pallidum by TPPA; (iii) JHR following treatment; (iv) dramatic response to antisyphilis therapy.…”

Sífilis maligna como manifestación clínica atípica de sífilis secundaria

“…La transmisión puede ocurrir por contacto sexual a través de lesiones mucocutáneas pequeñas (vía más común), vía vertical, y en la actualidad raramente por transfusión sanguínea o donación de órganos (13). La SM es una variante poco común de sífilis secundaria, donde la mayoría de los pacientes se encuentran inmunocomprometidos o presentan un mal estado de salud (11,14,15). La patogénesis de la sífilis maligna es desconocida; sin embargo, se reconoce que es más común en pacientes con coinfección con VIH (10).…”

Whole genome sequence of a Treponema pallidum strain from a formalin-fixed paraffin-embedded fine needle aspirate of a cervical lymph node

“…Because syphilis is a disease with protean clinical manifestations, one would expect to encounter uncommon clinical manifestations as the cases increase 2 . Two such uncommon clinical manifestations of syphilis are isolated cervical adenopathy 3 and “malignant” syphilis, defined as an aggressive inflammatory condition in which skin ulcerations develop with a large number of spirochetes present 4–6 …”

“…2 Two such uncommon clinical manifestations of syphilis are isolated cervical adenopathy 3 and "malignant" syphilis, defined as an aggressive inflammatory condition in which skin ulcerations develop with a large number of spirochetes present. [4][5][6] Traditionally, infecting rabbits intratesticularly with Treponema pallidum-containing patient samples has been the investigator's choice to attain sufficient microbial cells to perform whole genome sequencing (WGS), which provided valuable insights in the macroevolution and microevolution of the syphilis agent since its isolation in 1912. 7 The use of DNA directly extracted from fresh patient samples, such as early lesion or oral swabs, has recently become an available option, thanks to molecular approaches able to enrich T. pallidum DNA before sequencing.…”