Secondary syphilis masquerading as lupus vulgaris in an HIV-infected patient: A diagnosis suggested by histology

Abstract

We report a case of secondary syphilis mimicking lupus vulgaris in an HIV-infected patient. A 21-year-old Brazilian man presented with a two-month history of asymptomatic cutaneous lesions accompanied by fever and fatigue. Dermatological evaluation revealed an erythematous, crusted, large plaque on the neck with the 'apple jelly' sign on diascopy and two smaller scaly elements on the trunk and left palm. Bacteriological examinations for bacteria and mycobacteria gave negative results. Histology revealed psoriasiform epidermal hyperplasia and dermal lymphoplasmacytic infiltrate. Serology for syphilis was positive, and immunohistochemistry confirmed the presence of Treponema pallidum in lesional skin. A diagnosis of secondary syphilis was made, and the patient was successfully treated with benzathine penicillin G. Cutaneous manifestations of secondary syphilis are protean and skin tuberculosis may be considered in the differential diagnosis, especially in HIV-infected patients. In the current case, clinical examination, and particularly, 'apple jelly' sign positivity, was suggestive of lupus vulgaris, but only typical histopathology and immunohistochemistry led to the correct diagnosis of secondary syphilis.

Delayed Onset and Protracted Course of Psoriasis-like Secondary Syphilitic Lesions in a HIV-sero­positive Man Who has Sex with Men: A Case Report

“…The early diagnosis and treatment of syphilis in HIVinfected patients is challenging due to atypical clinical features and deviations from the expected course (15). In this case, the patient had been misdiagnosed with psoriasis for more than one year and was finally diagnosed by skin lesion biopsy and serological tests for syphilis.…”

Nodulo-ulcerative and erythrodermic secondary syphilis in human immunodeficiency virus-infected individuals

“…3,4,8 Unusual presentations of secondary syphilis in HIV include papular, nodular or ulcerative lesions with necrotic centres (lues maligna), keratoderma 9 and en-plaque lesions. 10 Pruritus is not a common feature of secondary syphilis, but it is rarely noted in papular, follicular and lichenoid variants. 11 Erythroderma is rarely reported in secondary syphilis.…”

Secunder syphilis treated as tinea

“…Immunszupprimált állapotban, például HIV-fertőzés egyidejű fennállása esetén a klinikai kép még változatosabb lehet (13). Az általunk ismertetett beteg esetében immuszupprimált állapot nem igazolódott.…”