Secondary syphilis: a clinico-pathological review

Abstract

The histological appearances found in biopsies from fifty-seven patients with secondary syphilis have been correlated with the clinical morphology of the eruptions. Considerable variation of histological pattern was encountered, and the frequency with which some of the classically described changes were found to be absent or inconspicuous is stressed. Of particular interest were the findings that, in nearly one-quarter of the biopsies, plasma cell infiltration was either absent or very sparse, and that vascular damage was seen in less than half. Where present, the vessel changes were almost entirely confined to swelling of the endothelial cells. Proliferation of the endothelial cells was most uncommon. The epidermis was very frequently involved in the inflammatory process. Exocytosis, spongiosis, parakeratosis, and acanthosis were the most frequent changes. No consistent histological difference between papular and papulo-squamous lesions could be found but macular lesions demonstrated more superficial and less intense dermal infiltration as well as less severe epidermal involvement. In late secondary lesions, the infiltrate became granulomatous, but in other respects the duration of the exanthem could not be correlated with the pathology. The differential diagnosis from pityriasis lichenoides and other inflammatory dermatoses is discussed and the value of histopathology in the diagnosis of secondary syphilis is emphasized.

A Case of Secondary Syphilis with a Solitary Pulmonary Lesion

“…Classical examples of histolog ical changes in secondary syphilis are perivascular cell infiltrate with plasma cells and endothelial damage of small blood ves sels. Abell and Marks [7] described that plasma cell infiltration was either absent or very sparse in nearly one quarter of the cases and that vascular damage was seen in less than half. Even epithelioid cell granulomas occur occasionaly in secondary syphilis, es pecially in the late stage.…”

Invisible dermatoses

“…[20,21] Other common reported findings include erythema multiforme pattern of papillary oedema and perivascular lymphohistiocytic infiltration. [22,23] Histological resemblance to indeterminate leprosy has been reported. [24] The tissue reaction is particularly mild in patients with macular lesions.…”

Treponema pallidum, the syphilis spirochete: making a living as a stealth pathogen

“…Spirochetes replicating in tissues elicit a complex and variable inflammatory cell infiltrate consisting of macrophages, CD4 + and CD8 + T lymphocytes, and plasma cells, accompanied by varying degrees of endothelial cell swelling and proliferation. Production of IFN-γ by locally activated CD4+ and CD8+ T cells enhances the capacity of macrophages to internalize and degrade spirochetes but also bolsters their output of potentially tissue damaging, proinflammatory cytokines 22–26 .…”