Asunto(s)
Sífilis , Humanos , Masculino , Sífilis/diagnóstico , Sífilis/tratamiento farmacológico , Sífilis/microbiología , Treponema pallidum/aislamiento & purificación , Antibacterianos/uso terapéutico , Resultado del Tratamiento , Adulto , Sífilis Cutánea/tratamiento farmacológico , Sífilis Cutánea/diagnóstico , Sífilis Cutánea/microbiología , Sífilis Cutánea/patología , Serodiagnóstico de la Sífilis , Biopsia , Piel/patología , Piel/microbiologíaRESUMEN
ABSTRACT: Tertiary syphilis may present a diagnostic challenge due to negative nontreponemal serologies in up to 30% of cases and frequent lack of identifiable spirochetes on histopathology or other direct detection tests. We report 2 cases of round bodies staining with Treponema pallidum immunohistochemistry by light microscopy in biopsies from cutaneous syphilitic gummata. In 1 case, the finding was validated 3 times by 2 independent laboratories; in the other case, T. pallidum was detected by polymerase chain reaction in the biopsy sample. Spirochete round bodies have previously been reported in the setting of electron microscopy and fluorography, but to the best of our knowledge, have not been reported by light microscopy in a routine skin biopsy. Although the clinical implications are unclear, this may represent a helpful new paradigm for the diagnosis of tertiary syphilis.
Asunto(s)
Sífilis Cutánea , Sífilis , Humanos , Treponema pallidum , Sífilis Cutánea/diagnóstico , Sífilis Cutánea/patología , Colorantes , Sífilis/diagnóstico , Sífilis/patologíaAsunto(s)
Canal Anal , Condiloma Acuminado/diagnóstico , Sífilis Cutánea/diagnóstico , Sífilis/diagnóstico , Treponema pallidum/aislamiento & purificación , Adulto , Canal Anal/microbiología , Canal Anal/patología , Canal Anal/cirugía , Diagnóstico Diferencial , Humanos , Masculino , Valor Predictivo de las Pruebas , Sífilis/microbiología , Sífilis/patología , Sífilis/cirugía , Sífilis Cutánea/microbiología , Sífilis Cutánea/patología , Sífilis Cutánea/cirugíaAsunto(s)
Condiloma Acuminado , Enfermedades Gastrointestinales , Infecciones por VIH , Neoplasias Cutáneas , Sífilis Cutánea , Sífilis , Humanos , Sífilis/complicaciones , Sífilis/tratamiento farmacológico , Sífilis/patología , Doxiciclina/uso terapéutico , Sífilis Cutánea/patología , Condiloma Acuminado/complicaciones , Condiloma Acuminado/tratamiento farmacológico , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológicoAsunto(s)
Sífilis Cutánea/diagnóstico , Sífilis/diagnóstico , Adulto , Humanos , Masculino , Sífilis/patología , Sífilis Cutánea/patologíaRESUMEN
We describe a 17-year-old man who developed penile annular and scrotal eczematoid syphilids with penile chancre redux. Dermoscopy showed linear-irregular and hairpin vessels with white scales in annular lesions. Histopathology displayed psoriasiform hyperplasia with perivascular lymphoplasmacytic dermal infiltrate. Rapid plasma reagin and Treponema pallidumparticle agglutination assays were positive. The lesions disappeared after intramuscular benzathine penicillin.
Asunto(s)
Chancro/patología , Sífilis Cutánea/patología , Adolescente , Antibacterianos/uso terapéutico , Chancro/diagnóstico por imagen , Chancro/tratamiento farmacológico , Dermoscopía , Humanos , Masculino , Penicilina G Benzatina/uso terapéutico , Pene/diagnóstico por imagen , Pene/patología , Escroto/diagnóstico por imagen , Escroto/patología , Sífilis Cutánea/diagnóstico por imagen , Sífilis Cutánea/tratamiento farmacológico , Resultado del TratamientoRESUMEN
Nodular secondary syphilis is an uncommon variant of secondary syphilis. We identified three cases of nodular secondary syphilis at our institution. The first patient presented with a diffuse nodular rash that included his scrotum and penis. The second patient had disseminated skin-colored nodules with serosanguinous crust on his face, trunk, and extremities. The third patient had a pruritic papular and nodular rash with overlying crust. All three patients had a reactive rapid plasma reagin and tested positive for fluorescent treponemal antibody absorption. All were eventually confirmed to be human immunodeficiency virus-positive. Histopathological examination demonstrated inflammatory infiltrate in the dermis composed of lymphocytes, histiocytes, and plasma cells, and treponemal staining highlighted spirochetes in the dermis. The patients were successfully treated with intramuscular penicillin benzathine G. Physicians should be aware of nodular syphilis as a less common cutaneous manifestation of secondary syphilis. Prompt diagnosis of secondary syphilis can expedite resolution of the infection and avoid progression to tertiary syphilis.
Asunto(s)
Seropositividad para VIH/complicaciones , Penicilina G Benzatina/uso terapéutico , Sífilis/tratamiento farmacológico , Treponema pallidum/aislamiento & purificación , Adulto , Exantema/patología , Humanos , Masculino , Penicilina G Benzatina/administración & dosificación , Sífilis/diagnóstico , Serodiagnóstico de la Sífilis , Sífilis Cutánea/patología , Resultado del Tratamiento , Treponema pallidum/inmunologíaRESUMEN
Syphilis is a sexually transmitted disease caused by the spirochetal bacterium Treponema pallidum that has been of public health concern for centuries. In the United States, it is currently a reportable disease and one which is recently generating increasing case numbers especially in at risk populations of immune deficiency and men who have sex with men. The present series examines biopsies from 13 patients collected over a 12-year period from a general hospital network in north suburban Cook County, Illinois. There were 13 patients (11 male: 2 female) with varied presentations, including primary ulcerated anogenital chancres, mucosal lesions, peculiar rashes, and alopecia. The reason(s) for biopsy were not clear from the clinical record, as a clinical consideration of syphilis was recorded in only 3 cases. Histologic examination of the mucocutaneous lesions encompassed a spectrum of findings including ulceration, psoriasiform hyperplasia, intense mixed band-like inflammation at the dermal-epidermal junction with a prominent plasma cell component. The contemporary availability of an effective immunostain is a valuable diagnostic adjunct. The organisms generally parallel the intensity of the inflammatory infiltrate but the distribution may vary and rarely, organisms may be absent despite serologic confirmation. Previous corkscrew morphology of the organism described ultrastructurally is reflected in the immunostained representation. Although the diagnosis of syphilis remains a clinical one in most cases, some patients will have unusual presentations and biopsies will be done. The awareness of the pathologist will facilitate prompt and effective treatment.
Asunto(s)
Chancro/patología , Mucosa Intestinal/patología , Mucosa Bucal/patología , Recto/patología , Piel/patología , Sífilis Cutánea/patología , Treponema pallidum/patogenicidad , Adulto , Alopecia/microbiología , Biopsia , Chancro/microbiología , Femenino , Interacciones Huésped-Patógeno , Humanos , Illinois , Mucosa Intestinal/microbiología , Masculino , Persona de Mediana Edad , Mucosa Bucal/microbiología , Valor Predictivo de las Pruebas , Recto/microbiología , Piel/microbiología , Sífilis Cutánea/microbiología , Adulto JovenRESUMEN
Annular syphilis may range from mildly raised lesions with scaly borders to verrucous plaques. Localized annular syphilis on the genitalia has been rarely reported in HIV-negative cases. This paper reports a case of annular secondary syphilis on the penis. Dermoscopy showed peripheral dotted and short linear vessels and white scaling with a relatively clear central area in an erythematous annular plaque. Histopathology revealed mild hyperkeratosis, parakeratosis, psoriasiform acanthosis, and focal basal vacuolar degeneration with lichenoid, perivascular, and periadnexal infiltrate of lymphohistiocytes and plasma cells in the superficial dermis. Silver stain showed several spirochetes in the lower epidermis and superficial dermis. Electron microscopy revealed a few intercellular and intracytoplasmic spirochetes in the basal epidermis and free spirochetes in the papillary dermis. Rapid plasma reagin and Treponema pallidum particle agglutination assays were positive. The lesions disappeared after intramuscular benzathine penicillin, with no relapse at six-month follow-up.
Asunto(s)
Pene/patología , Sífilis Cutánea/patología , Sífilis/diagnóstico , Treponema pallidum/aislamiento & purificación , Adulto , Humanos , Masculino , Microscopía Electrónica , Penicilina G Benzatina/uso terapéutico , Sífilis/tratamiento farmacológico , Serodiagnóstico de la Sífilis , Resultado del TratamientoRESUMEN
It is essential for health care providers to be familiared with the full spectrum of clinical presentations of syphilis. We present herein a case of syphilide psoriasiforme, an uncommon but well recognized clinical presentation of secondary syphilis. A 46-year-old HIV-infected female patient was referred to our attention with a presumptive diagnosis of palmoplantar psoriasis. On examination, there were exuberant pinkish-red papules and plaques covered with a thick silvery scale in the palms, flexor surfaces of the wrists, and the medial longitudinal arches of the feet. Serological and histopathological analyses uncovered the diagnosis of syphilis. Clinical remission was obtained after treatment. A detailed review of the literature on syphilide psoriasiforme, including descriptions from older syphilology textsis provided. The present case report emphasizes the need for clinicians to have a heightened awareness of the varied and unusual clinical phenotypes of syphilis.
Asunto(s)
Penicilina G Benzatina/administración & dosificación , Sífilis Cutánea/diagnóstico , Femenino , Humanos , Persona de Mediana Edad , Sífilis Cutánea/tratamiento farmacológico , Sífilis Cutánea/patologíaAsunto(s)
Pie/patología , Mano/patología , Sífilis Cutánea , Adulto , Femenino , Humanos , Sífilis Cutánea/diagnóstico , Sífilis Cutánea/patología , Adulto JovenAsunto(s)
Úlcera del Pie/diagnóstico , Sífilis Cutánea/diagnóstico , Sífilis/diagnóstico , Chancro/terapia , Femenino , Úlcera del Pie/patología , Humanos , Persona de Mediana Edad , Neoplasias Cutáneas/diagnóstico , Sífilis/patología , Serodiagnóstico de la Sífilis , Sífilis Cutánea/patología , Factores de TiempoAsunto(s)
Dendritas , Melanocitos , Piel , Sífilis Cutánea , Treponema pallidum , Dendritas/metabolismo , Dendritas/patología , Humanos , Inmunohistoquímica , Melanocitos/metabolismo , Melanocitos/patología , Piel/metabolismo , Piel/patología , Sífilis Cutánea/metabolismo , Sífilis Cutánea/patologíaRESUMEN
Condyloma lata, a cutaneous manifestation of secondary syphilis, usually appear as verrucous papules and plaques in the anogenital area. Involvement of the umbilicus is very uncommon. Thus, awareness of this presentation, along with appropriate history, physical exam, and laboratory testing may aid clinicians in prompt and accurate diagnosis. We describe a patient with an unusual presentation of condyloma lata on the umbilicus.
Asunto(s)
Sífilis Cutánea/diagnóstico , Sífilis/diagnóstico , Adulto , Humanos , Masculino , Sífilis/tratamiento farmacológico , Sífilis/patología , Sífilis Cutánea/tratamiento farmacológico , Sífilis Cutánea/patología , OmbligoAsunto(s)
Eritema/patología , Neoplasias Cutáneas/patología , Úlcera Cutánea/patología , Sífilis Cutánea/patología , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Exantema/etiología , Humanos , Inyecciones Intramusculares , Linfadenopatía/etiología , Linfadenopatía/patología , Masculino , Penicilina G Benzatina/administración & dosificación , Penicilina G Benzatina/uso terapéutico , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/microbiología , Enfermedades de Transmisión Sexual/patología , Sífilis Cutánea/tratamiento farmacológico , Sífilis Cutánea/microbiología , Tonsilitis/diagnóstico , Tonsilitis/etiología , Resultado del Tratamiento , Treponema pallidum/aislamiento & purificación , Adulto JovenAsunto(s)
Infecciones por VIH , VIH-1 , Sífilis Cutánea , Vasculitis Leucocitoclástica Cutánea , Adulto , Infecciones por VIH/metabolismo , Infecciones por VIH/microbiología , Infecciones por VIH/patología , Humanos , Masculino , Sífilis Cutánea/metabolismo , Sífilis Cutánea/patología , Sífilis Cutánea/virología , Vasculitis Leucocitoclástica Cutánea/metabolismo , Vasculitis Leucocitoclástica Cutánea/microbiología , Vasculitis Leucocitoclástica Cutánea/patología , Vasculitis Leucocitoclástica Cutánea/virologíaAsunto(s)
Neurosífilis , Manejo de Atención al Paciente , Penicilina G/administración & dosificación , Sífilis Cutánea , Treponema pallidum/aislamiento & purificación , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Biopsia/métodos , Femenino , Humanos , Pruebas Inmunológicas/métodos , Imagen por Resonancia Magnética/métodos , Neurosífilis/líquido cefalorraquídeo , Neurosífilis/diagnóstico , Neurosífilis/tratamiento farmacológico , Neurosífilis/fisiopatología , Gravedad del Paciente , Manejo de Atención al Paciente/métodos , Manejo de Atención al Paciente/normas , Sífilis Cutánea/tratamiento farmacológico , Sífilis Cutánea/patología , Resultado del TratamientoRESUMEN
Syphilis is a sexually transmitted disease that can affect multiple organ systems, with central nervous system involvement at any stage. We present a 53-year-old woman with an unusual truncal rash with painful anogenital lesions, accompanied by patchy alopecia, oral lesions, photophobia and hoarseness. She was found to have positive serological tests for syphilis with cerebrospinal fluid findings suggestive of neurosyphilis. She underwent a 14-day course of intravenous penicillin G and exhibited successful resolution of painful anogenital lesions as well as marked improvement in dermatological, oropharyngeal, laryngeal, and neurological symptoms.
Asunto(s)
Ronquera/diagnóstico , Neurosífilis/diagnóstico , Sífilis Cutánea/diagnóstico , Alopecia/complicaciones , Alopecia/diagnóstico , Alopecia/tratamiento farmacológico , Alopecia/patología , Antibacterianos/uso terapéutico , Enfermedades del Ano/complicaciones , Enfermedades del Ano/diagnóstico , Enfermedades del Ano/tratamiento farmacológico , Enfermedades del Ano/patología , Femenino , Cefalea/etiología , Ronquera/tratamiento farmacológico , Ronquera/etiología , Humanos , Enfermedades de la Laringe/complicaciones , Enfermedades de la Laringe/diagnóstico , Enfermedades de la Laringe/tratamiento farmacológico , Persona de Mediana Edad , Enfermedades de la Boca/complicaciones , Enfermedades de la Boca/diagnóstico , Enfermedades de la Boca/tratamiento farmacológico , Enfermedades de la Boca/patología , Neurosífilis/líquido cefalorraquídeo , Neurosífilis/complicaciones , Neurosífilis/tratamiento farmacológico , Paladar Duro , Penicilina G/uso terapéutico , Fotofobia/etiología , Sífilis Cutánea/tratamiento farmacológico , Sífilis Cutánea/patología , Enfermedades de la Vulva/complicaciones , Enfermedades de la Vulva/diagnóstico , Enfermedades de la Vulva/tratamiento farmacológico , Enfermedades de la Vulva/patologíaRESUMEN
The number of cases of syphilis continues to rise in the UK, USA and elsewhere and may present to a variety of clinical specialties. We report a complex case of early acquired disseminated syphilis causing an ulceronodular rash (lues maligna), orchitis, osteitis and lung nodules in an immunocompetent man who has sex with men who presented to the genitourinary medicine clinic. Syphilis should be considered in the differential diagnoses of multiple clinical presentations and optimal management should involve multidisciplinary care.