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Secondary syphilis masquerading as lupus vulgaris in an HIV-infected patient: A diagnosis suggested by histology.
Int J STD AIDS. 2018 12; 29(14):1454-1456.IJ

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.

Authors+Show Affiliations

Dermatology Unit, Department of Physiopathology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.Dermatology Unit, Department of Physiopathology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.Dermatology Unit, Department of Physiopathology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.Dermatology Unit, Department of Physiopathology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.Dermatology Unit, Department of Physiopathology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.Dermatology Unit, Department of Physiopathology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

30170530

Citation

Genovese, Giovanni, et al. "Secondary Syphilis Masquerading as Lupus Vulgaris in an HIV-infected Patient: a Diagnosis Suggested By Histology." International Journal of STD & AIDS, vol. 29, no. 14, 2018, pp. 1454-1456.
Genovese G, Nazzaro G, Coggi A, et al. Secondary syphilis masquerading as lupus vulgaris in an HIV-infected patient: A diagnosis suggested by histology. Int J STD AIDS. 2018;29(14):1454-1456.
Genovese, G., Nazzaro, G., Coggi, A., Gianotti, R., Ramoni, S., & Cusini, M. (2018). Secondary syphilis masquerading as lupus vulgaris in an HIV-infected patient: A diagnosis suggested by histology. International Journal of STD & AIDS, 29(14), 1454-1456. https://doi.org/10.1177/0956462418795590
Genovese G, et al. Secondary Syphilis Masquerading as Lupus Vulgaris in an HIV-infected Patient: a Diagnosis Suggested By Histology. Int J STD AIDS. 2018;29(14):1454-1456. PubMed PMID: 30170530.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Secondary syphilis masquerading as lupus vulgaris in an HIV-infected patient: A diagnosis suggested by histology. AU - Genovese,Giovanni, AU - Nazzaro,Gianluca, AU - Coggi,Antonella, AU - Gianotti,Raffaele, AU - Ramoni,Stefano, AU - Cusini,Marco, Y1 - 2018/08/31/ PY - 2018/9/2/pubmed PY - 2019/6/7/medline PY - 2018/9/2/entrez KW - Syphilis KW - human immunodeficiency virus KW - lupus vulgaris KW - tuberculosis SP - 1454 EP - 1456 JF - International journal of STD & AIDS JO - Int J STD AIDS VL - 29 IS - 14 N2 - 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. SN - 1758-1052 UR - https://www.unboundmedicine.com/medline/citation/30170530/Secondary_syphilis_masquerading_as_lupus_vulgaris_in_an_HIV_infected_patient:_A_diagnosis_suggested_by_histology_ L2 - https://journals.sagepub.com/doi/10.1177/0956462418795590?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -