Oyster Shell-Like Skin Lesions in a Young Man

Liu, J.‐W.; Ma, Dong‐Lai

doi:10.1016/j.mayocp.2020.12.001

Cited by 4 publications

(4 citation statements)

References 2 publications

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Section: Discussionsupporting

confidence: 91%

“…Although positive immunohistochemistry results and the absence of spirochetes have been reported in MS in the literature [14], immunohistochemistry was not positive in our samples. Warthin-Starry staining was diagnostic for T. pallidum infection in our patient's biopsy samples, consistent with the literature [15]. Interestingly, our case mimicked a cutaneous T-cell lymphoma clinically, histologically and molecularly by expressing monoclonality with rearrangements in the T-cell receptor beta (TCRB) gene.…”

Section: Discussionsupporting

confidence: 88%

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

et al. 2022

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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.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 88%

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

et al. 2022

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“…In rare cases, it may also in patients with normal immune function. Liu, JW previously reported a healthy man with multiple scattered erythematous plaques, conical, oyster shell-shaped, dirty-looking, hyperkeratotic crusts all over his body, diagnosed as rupioid secondary syphilis (Liu and Ma, 2021). However, in our case, the patient was previously in good health, and the rash was only confined to the face, which is extremely rare.…”

Section: Discussionmentioning

confidence: 55%

“…It usually involves the palms and soles of the feet, but may also present as papular, nodular, nodular ulcerative, follicular, pustular, annular, and lichenoid eruptions (Qian and Ma, 2019). Rupioid syphilis is relatively rare, and it usually manifests as skin all over the body (Liu and Ma, 2021). In this case, we present a case of a young woman who developed an annular oyster shell-like secondary syphilis of the face.…”

Section: Introductionmentioning

confidence: 94%

Annular rupioid secondary syphilis confined to the face

Yu¹,

Che²,

Song³

et al. 2022

International Journal of Infectious Diseases

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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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Oyster Shell-Like Skin Lesions in a Young Man

Cited by 4 publications

References 2 publications

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

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

Annular rupioid secondary syphilis confined to the face

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

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