Nodular secondary syphilis in a woman

Abstract

We report the case of a 21-year-old woman with symmetrically distributed, ulcerated nodules and plaques on the face, neck and arms. Initial differential diagnoses included pyoderma or sarcoidosis based on the clinical presentation and histopathology with non-caseating granulomas. After inefficient treatment with topical and systemic fusidic acid and steroids, we diagnosed nodular secondary syphilis owing to positive serology and immunohistochemical staining of Treponema pallidum in lesional skin. After treatment with benzathine penicillin, skin lesions improved and antibody titres declined significantly within 3 months. Nodular skin lesions in secondary syphilis are rare with 15 reported cases within the last 20 years. Furthermore, the granulomatous histology is often misleading. Our patient's case suggests that the physicians should be aware of syphilis as a possible differential diagnosis also in patients outside a high-risk population for sexually transmitted diseases and with an unusual clinical presentation.

Granulomatous Syphilis: A Pattern to Remember. Case Report and Review of Literature

“…Review of the English literature for cases of secondary syphilis with no mucosal or genital lesions and without involvement of palms and soles reveals that most of these cases were characterized by a prominent histiocytic inflammatory infiltrate ( of reported cases of syphilis, there was a male predominance with only 3 of the patients, including the current case being female [15,19]. In most patients, the duration of skin lesions before presentation was 12 weeks or less, with exception of one patient [20].…”

“…Granulomatous inflammation is a hallmark of tertiary syphilis, which also presents with massive caseating necrosis [10][11][12][13]. Though uncommon, a prominent histiocytic inflammatory infiltrate has been described in lesions of secondary syphilis as well [11,[14][15][16][17]. In most cases, the presence of mucosal ulcerations, involvement of palms and soles as well as genital lesions is usually the tip-off that raises the possibility of syphilis.…”

“…In most patients, the duration of skin lesions before presentation was 12 weeks or less, with exception of one patient [20]. The lesions range from plaques to papules to nodules and are rarely ulcerated [15]. Face, upper trunk and upper extremities are the commonly affected areas, while lower back and intertriginous areas are rarely affected [21].…”

Clinical manifestations of syphilis in maxillofacial area. Part I

“…сhancre -язвочка) представлен эрозией или язвой блюдцеобразной формы с четкими краями. Эрозия имеет округлые очертания, она мясо-красного цвета с «лакированной» поверхностью или сероватого цвета, с плотным инфильтратом в основании на интактном фоне; субъективные ощущения отсутствуют [6]. Через 5-7 дней увеличиваются регионарные лимфатические узлы (склераденит), для которых характерны плотность, подвижность, безболезненность.…”

Clinical manifestations of syphilis in maxillofacial area. Part II

“…Более чем в 50% случаев у больных вторичным сифилисом выявляются поражения слизистой оболочки полости рта (ПР) [2]. Слизистая ротовой полости, часто раздражаемая острой пищей, курением, бактериальной флорой, является locus minoris resistentiae при гематогенной диссеминации инфекции во вторичном периоде, обусловливая частоту рецидивов сифилидов в этой области [3]. *Тел.…”