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Lues maligna praecox: an important consideration in HIV-positive patients with ulceronodular skin lesions.
Dermatol Online J. 2014 Dec 14; 21(3)DO

Abstract

Syphilis is commonly known as "the great imitator" owing to its varied clinical manifestations. Secondary syphilis has a variety of presentations, with the most common manifesting as a diffuse papulosquamous eruption on the palms and soles. Lues maligna praecox is a rare form of secondary syphilis, with severe constitutional symptoms, seen primarily in HIV-positive individuals. We report an atypical case of suspected lues maligna in a 45-year-old male. The patient was HIV-positive with a CD4 count of 441. He presented to our clinic with large painful gummatous ulcers in the groin and lower back. He also reported daily fevers, night sweats, and weight loss consistent with secondary syphilis. Prior to this episode the patient had a history of acute active syphilis (RPR 1:128) in 2012 treated at that time with a single dose of 2.4 million units intramuscular benzathine penicillin; he had no reported exposures since that time. The patient was treated with three weekly doses of benzathine penicillin, 2.4 million units, given intramuscularly. This case demonstrates the importance of recognizing the varied clinical presentation of secondary syphilis and keeping lues maligna in consideration for ulceronodular skin lesions in patients who are HIV-positive.

Authors+Show Affiliations

University of Kansas Medical Center - Department of Dermatology.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

25780966

Citation

Hanson, Cody, et al. "Lues Maligna Praecox: an Important Consideration in HIV-positive Patients With Ulceronodular Skin Lesions." Dermatology Online Journal, vol. 21, no. 3, 2014.
Hanson C, Fischer R, Fraga G, et al. Lues maligna praecox: an important consideration in HIV-positive patients with ulceronodular skin lesions. Dermatol Online J. 2014;21(3).
Hanson, C., Fischer, R., Fraga, G., Rajpara, A., Hinthorn, D., Aires, D., & Liu, D. (2014). Lues maligna praecox: an important consideration in HIV-positive patients with ulceronodular skin lesions. Dermatology Online Journal, 21(3).
Hanson C, et al. Lues Maligna Praecox: an Important Consideration in HIV-positive Patients With Ulceronodular Skin Lesions. Dermatol Online J. 2014 Dec 14;21(3) PubMed PMID: 25780966.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lues maligna praecox: an important consideration in HIV-positive patients with ulceronodular skin lesions. AU - Hanson,Cody, AU - Fischer,Ryan, AU - Fraga,Garth, AU - Rajpara,Anand, AU - Hinthorn,Daniel, AU - Aires,Daniel, AU - Liu,Deede, Y1 - 2014/12/14/ PY - 2014/09/18/received PY - 2014/12/14/accepted PY - 2014/12/13/revised PY - 2015/3/18/entrez PY - 2014/1/1/pubmed PY - 2015/12/15/medline JF - Dermatology online journal JO - Dermatol. Online J. VL - 21 IS - 3 N2 - Syphilis is commonly known as "the great imitator" owing to its varied clinical manifestations. Secondary syphilis has a variety of presentations, with the most common manifesting as a diffuse papulosquamous eruption on the palms and soles. Lues maligna praecox is a rare form of secondary syphilis, with severe constitutional symptoms, seen primarily in HIV-positive individuals. We report an atypical case of suspected lues maligna in a 45-year-old male. The patient was HIV-positive with a CD4 count of 441. He presented to our clinic with large painful gummatous ulcers in the groin and lower back. He also reported daily fevers, night sweats, and weight loss consistent with secondary syphilis. Prior to this episode the patient had a history of acute active syphilis (RPR 1:128) in 2012 treated at that time with a single dose of 2.4 million units intramuscular benzathine penicillin; he had no reported exposures since that time. The patient was treated with three weekly doses of benzathine penicillin, 2.4 million units, given intramuscularly. This case demonstrates the importance of recognizing the varied clinical presentation of secondary syphilis and keeping lues maligna in consideration for ulceronodular skin lesions in patients who are HIV-positive. SN - 1087-2108 UR - https://www.unboundmedicine.com/medline/citation/25780966/Lues_maligna_praecox:_an_important_consideration_in_HIV_positive_patients_with_ulceronodular_skin_lesions_ L2 - http://escholarship.org/uc/item/5mj272nw DB - PRIME DP - Unbound Medicine ER -