Tags

Type your tag names separated by a space and hit enter

Multiple primary syphilis on the lip, nipple-areola and penis: An immunohistochemical examination of Treponema pallidum localization using an anti-T. pallidum antibody.
J Dermatol. 2015 May; 42(5):515-7.JD

Abstract

Primary syphilis caused by Treponema pallidum usually develops after sexual contact as an initial solitary sclerosis or hard chancre in the genital region. We describe a case of primary syphilis at three sites in genital and extragenital regions of a man who had sex with men. A 29-year-old man visited our hospital for skin lesions on his lower lip, nipple-areola and penis. A positive syphilis serological test for rapid plasma reagin had a titer of 1:16; the patient also tested positive for specific antibodies against T. pallidum, with a cut-off index of 39.0. Histopathological examination of a nipple-areola biopsy specimen revealed a thickened epidermis and dense infiltration of inflammatory cells extending from the upper dermal layers to the deep dermis. The inflammatory cells were composed of abundant lymphocytes, plasma cells, histiocytes and neutrophils. Immunohistochemical staining for T. pallidum using an anti-T. pallidum antibody showed numerous spirochetes in the lower portion of the epidermis, scattered inside inflammatory cell infiltrate and perivascular sites throughout the dermis. Based on these findings, the patient was diagnosed with primary syphilis. Treatment with oral amoxicillin hydrate was started. Five days after starting treatment, a diffuse maculopapular rash (syphilitic roseola) occurred on his trunk and extremities. Perivascular cuffing due to T. pallidum was present throughout the dermis in the biopsy specimen of a localized lesion of primary syphilis. Moreover, syphilitic roseola, which indicates generalized dissemination of T. pallidum, developed during the course of treatment for primary syphilis. Therefore, we considered perivascular cuffing to be indicative of the dissemination phase.

Authors+Show Affiliations

Department of Dermatology, Toho University Ohashi Medical Center, Tokyo, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

25708895

Citation

Fukuda, Hidetsugu, et al. "Multiple Primary Syphilis On the Lip, Nipple-areola and Penis: an Immunohistochemical Examination of Treponema Pallidum Localization Using an anti-T. Pallidum Antibody." The Journal of Dermatology, vol. 42, no. 5, 2015, pp. 515-7.
Fukuda H, Takahashi M, Kato K, et al. Multiple primary syphilis on the lip, nipple-areola and penis: An immunohistochemical examination of Treponema pallidum localization using an anti-T. pallidum antibody. J Dermatol. 2015;42(5):515-7.
Fukuda, H., Takahashi, M., Kato, K., Oharaseki, T., & Mukai, H. (2015). Multiple primary syphilis on the lip, nipple-areola and penis: An immunohistochemical examination of Treponema pallidum localization using an anti-T. pallidum antibody. The Journal of Dermatology, 42(5), 515-7. https://doi.org/10.1111/1346-8138.12818
Fukuda H, et al. Multiple Primary Syphilis On the Lip, Nipple-areola and Penis: an Immunohistochemical Examination of Treponema Pallidum Localization Using an anti-T. Pallidum Antibody. J Dermatol. 2015;42(5):515-7. PubMed PMID: 25708895.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multiple primary syphilis on the lip, nipple-areola and penis: An immunohistochemical examination of Treponema pallidum localization using an anti-T. pallidum antibody. AU - Fukuda,Hidetsugu, AU - Takahashi,Misaki, AU - Kato,Keiichi, AU - Oharaseki,Toshiaki, AU - Mukai,Hideki, Y1 - 2015/02/24/ PY - 2014/10/20/received PY - 2015/01/12/accepted PY - 2015/2/25/entrez PY - 2015/2/25/pubmed PY - 2016/12/15/medline KW - Treponema pallidum KW - hard chancre KW - initial sclerosis KW - primary syphilis KW - syphilis SP - 515 EP - 7 JF - The Journal of dermatology JO - J Dermatol VL - 42 IS - 5 N2 - Primary syphilis caused by Treponema pallidum usually develops after sexual contact as an initial solitary sclerosis or hard chancre in the genital region. We describe a case of primary syphilis at three sites in genital and extragenital regions of a man who had sex with men. A 29-year-old man visited our hospital for skin lesions on his lower lip, nipple-areola and penis. A positive syphilis serological test for rapid plasma reagin had a titer of 1:16; the patient also tested positive for specific antibodies against T. pallidum, with a cut-off index of 39.0. Histopathological examination of a nipple-areola biopsy specimen revealed a thickened epidermis and dense infiltration of inflammatory cells extending from the upper dermal layers to the deep dermis. The inflammatory cells were composed of abundant lymphocytes, plasma cells, histiocytes and neutrophils. Immunohistochemical staining for T. pallidum using an anti-T. pallidum antibody showed numerous spirochetes in the lower portion of the epidermis, scattered inside inflammatory cell infiltrate and perivascular sites throughout the dermis. Based on these findings, the patient was diagnosed with primary syphilis. Treatment with oral amoxicillin hydrate was started. Five days after starting treatment, a diffuse maculopapular rash (syphilitic roseola) occurred on his trunk and extremities. Perivascular cuffing due to T. pallidum was present throughout the dermis in the biopsy specimen of a localized lesion of primary syphilis. Moreover, syphilitic roseola, which indicates generalized dissemination of T. pallidum, developed during the course of treatment for primary syphilis. Therefore, we considered perivascular cuffing to be indicative of the dissemination phase. SN - 1346-8138 UR - https://www.unboundmedicine.com/medline/citation/25708895/Multiple_primary_syphilis_on_the_lip_nipple_areola_and_penis:_An_immunohistochemical_examination_of_Treponema_pallidum_localization_using_an_anti_T__pallidum_antibody_ L2 - https://doi.org/10.1111/1346-8138.12818 DB - PRIME DP - Unbound Medicine ER -