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Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma.
Diagn Pathol. 2015 Oct 08; 10:185.DP

Abstract

Malignant syphilis or lues maligna is a severe form of secondary syphilis that was commonly reported in the pre-antibiotic era, and has now reemerged with the advent of the human immunodeficiency virus (HIV) epidemic. However, the characteristic histopathological findings of malignant syphilis remain controversial. The aim of this case report was to clarify the clinical and histopathological findings of HIV-positive malignant secondary syphilis. A Japanese man in his forties complained of fever, skin lesions, headache, and myalgia without lymphadenopathy during the previous 4 weeks. The skin lesions manifested as erythematous, nonhealing, ulcerated papules scattered on his trunk, extremities, palm, and face. Although the skin lesions were suspected to be cutaneous T-cell lymphomas on histological analyses, they lacked T-cell receptor Jγ rearrangement; moreover, immunohistochemical analyses confirmed the presence of spirochetes. The patient was administered antibiotics and anti-retroviral therapy, which dramatically improved the symptoms. On the basis of these observations of the skin lesions, we finally diagnosed the patient with HIV-associated secondary syphilis that mimicked cutaneous T-cell lymphoma. The patient's systemic CD4+ lymphocyte count was very low, and the infiltrate was almost exclusively composed of CD8+ atypical lymphocytes; therefore, the condition was easily misdiagnosed as cutaneous lymphoma. Although the abundance of plasma cells is a good indicator of malignant syphilis on skin histological analyses, in some cases, the plasma cell count may be very low. Therefore, a diagnosis of malignant secondary syphilis should be considered before making a diagnosis of primary cutaneous peripheral T-cell lymphoma or lymphoma associated with HIV infection.

Authors+Show Affiliations

Division of Diagnostic Pathology, Tokushima Red Cross Hospital, 103, Irinokuchi, Komatsushima-cho, Komatsushima-shi, Tokushima, 7738502, Japan. akkunrikkun@gmail.com.Division of Diagnostic Pathology, Tokushima Red Cross Hospital, 103, Irinokuchi, Komatsushima-cho, Komatsushima-shi, Tokushima, 7738502, Japan. tn.byouri@tokushima-med.jrc.or.jp.Division of Hematology, Tokushima Red Cross Hospital, Tokushima, Japan. ozakei01@tokushima-med.jrc.or.jp.Division of Dermatology, Tokushima Red Cross Hospital, Tokushima, Japan. dermis@tokushima-u.ac.jp.Division of Hematology, Tokushima University Hospital, Tokushima, Japan. goodluck.183@hotmail.co.jp.Division of Hematology, Tokushima University Hospital, Tokushima, Japan. shingen@tokushima-u.ac.jp.Division of Hematology, Tokushima University Hospital, Tokushima, Japan. fujii.shiro@tokushima-u.ac.jp.Division of Hematology, Tokushima University Hospital, Tokushima, Japan. masabe@tokushima-u.ac.jp.Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan. satou-y@okayama-u.ac.jp.Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan. yoshino@md.okayama-u.ac.jp.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

26449225

Citation

Yamashita, Michiko, et al. "Human Immunodeficiency Virus-positive Secondary Syphilis Mimicking Cutaneous T-cell Lymphoma." Diagnostic Pathology, vol. 10, 2015, p. 185.
Yamashita M, Fujii Y, Ozaki K, et al. Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma. Diagn Pathol. 2015;10:185.
Yamashita, M., Fujii, Y., Ozaki, K., Urano, Y., Iwasa, M., Nakamura, S., Fujii, S., Abe, M., Sato, Y., & Yoshino, T. (2015). Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma. Diagnostic Pathology, 10, 185. https://doi.org/10.1186/s13000-015-0419-5
Yamashita M, et al. Human Immunodeficiency Virus-positive Secondary Syphilis Mimicking Cutaneous T-cell Lymphoma. Diagn Pathol. 2015 Oct 8;10:185. PubMed PMID: 26449225.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma. AU - Yamashita,Michiko, AU - Fujii,Yoshiyuki, AU - Ozaki,Keiji, AU - Urano,Yoshio, AU - Iwasa,Masami, AU - Nakamura,Shingen, AU - Fujii,Shiro, AU - Abe,Masahiro, AU - Sato,Yasuharu, AU - Yoshino,Tadashi, Y1 - 2015/10/08/ PY - 2015/07/30/received PY - 2015/10/01/accepted PY - 2015/10/10/entrez PY - 2015/10/10/pubmed PY - 2016/6/9/medline SP - 185 EP - 185 JF - Diagnostic pathology JO - Diagn Pathol VL - 10 N2 - Malignant syphilis or lues maligna is a severe form of secondary syphilis that was commonly reported in the pre-antibiotic era, and has now reemerged with the advent of the human immunodeficiency virus (HIV) epidemic. However, the characteristic histopathological findings of malignant syphilis remain controversial. The aim of this case report was to clarify the clinical and histopathological findings of HIV-positive malignant secondary syphilis. A Japanese man in his forties complained of fever, skin lesions, headache, and myalgia without lymphadenopathy during the previous 4 weeks. The skin lesions manifested as erythematous, nonhealing, ulcerated papules scattered on his trunk, extremities, palm, and face. Although the skin lesions were suspected to be cutaneous T-cell lymphomas on histological analyses, they lacked T-cell receptor Jγ rearrangement; moreover, immunohistochemical analyses confirmed the presence of spirochetes. The patient was administered antibiotics and anti-retroviral therapy, which dramatically improved the symptoms. On the basis of these observations of the skin lesions, we finally diagnosed the patient with HIV-associated secondary syphilis that mimicked cutaneous T-cell lymphoma. The patient's systemic CD4+ lymphocyte count was very low, and the infiltrate was almost exclusively composed of CD8+ atypical lymphocytes; therefore, the condition was easily misdiagnosed as cutaneous lymphoma. Although the abundance of plasma cells is a good indicator of malignant syphilis on skin histological analyses, in some cases, the plasma cell count may be very low. Therefore, a diagnosis of malignant secondary syphilis should be considered before making a diagnosis of primary cutaneous peripheral T-cell lymphoma or lymphoma associated with HIV infection. SN - 1746-1596 UR - https://www.unboundmedicine.com/medline/citation/26449225/Human_immunodeficiency_virus_positive_secondary_syphilis_mimicking_cutaneous_T_cell_lymphoma_ L2 - https://diagnosticpathology.biomedcentral.com/articles/10.1186/s13000-015-0419-5 DB - PRIME DP - Unbound Medicine ER -