Syphilis the great pretender: when is cancer not cancer?

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.

Sífilis secundaria con lesiones de la cavidad bucal como única manifestación clínica Presentación de 20 casos y revisión de la literatura / SECONDARY SYPHILIS WITH BUCAL CAVITY LESIONS AS SINGLE CLINICAL MANIFESTATION

La sífilis es una enfermedad infectocontagiosa causada por una espiroqueta: el Treponema pallidum. Se transmite por contacto directo (generalmente sexual) con las lesiones cutáneo-mucosas durante el estadio primario y secundario, por vía transplacentaria durante el embarazo o a través del pasaje por el canal uterino y por sangre. Se trata de una enfermedad sistémica con una gran variedad de manifestaciones clínicas. La sífilis secundaria cursa con manifestaciones generales de un síndrome infeccioso inespecífico y lesiones mucocutáneas características. La presentación clínica de los 20 pacientes que se describen en este trabajo es singular ya que solo poseían lesiones en la cavidad oral. Es importante considerar esta patología en el diagnóstico diferencial de lesiones mucosas orales, para realizar un diagnóstico temprano, tratamiento precoz y evitar el contagio, así como siempre descartar la asociación con infección por el retrovirus VIH

Syphilis is a sexually transmitted disease caused by the spirochete bacterium named as Treponema pallidum. Syphilis is transmitted by direct contact (generally non-protect sexual contact) with cutaneous and mucosal lesions during the primary and secondary periods, by trans-placental transmission if the mother develop the infection during pregnancy and by blood. Syphilis is a systemic disease with a wide variety of clinical manifestations. Secondary syphilis is characterized by a nonspecific infectious syndrome and mucocutaneous lesions. Here we describe a serie of 20 patients with secondary syphilis as the unique clinical manifestation. Secondary syphilis should be included in the differential diagnosis of oral cavity mucosal lesions to achieve an early diagnosis and avoid the contagion. Human immunodeficiency virus infection should be always considered

Casuística Sífilis secundaria maligna: forma clínica rupioide, en una paciente VIH positiva / MALIGNANT SECONDARY SYPHILIS: RAPIOID CLINICAL FORM, IN A HIV POSITIVE PATIENT

La sífilis maligna, también llamada sífilis nódulo-ulcerativa o lúes maligna, es una infrecuente pero grave forma de secundarismo,1 que en la actualidad se observa asociada a patologías como diabetes, tuberculosis, malnutrición, alcoholismo, drogadicción y pacientes VIH positivos2 . Caracterizada por lesiones cutáneas extensas, polimorfas que pueden ser pápulas, placas, tubérculos redondeados y lesiones ulceronecrónicas con centro cubierto por costras rupioides rodeadas por una halo sobrelevado eritematoso. Tienen escasa repercusión ganglionar y serio compromiso general que pueden comprometer la vida del paciente3 . Se presenta una paciente de 43 años con lesiones ulceronecróticas mutilantes de rápida evolución, con compromiso mucocutáneo. Con sospecha clínica de sífilis secundo-terciaria, se detecta serología reactiva para VIH

Malignant syphilis also called node-ulcerative syphilis or malignant lues, is an unusual but otherwise severe form of secundarism, that at present, is observed associated to pathologies such as diabetes, tuberculosis, malnutrition, alcoholism, drugaddiction, and to HIV positive patients. It is characterized by extended cutaneous polymorphous lesions that can be papules, plates, rounded tuberculous and ulceronecrotic lesions with a center covered by rupioid crusts surrounded by an eritematous overelevated border. They have small nodular involvement and serious general compromise that can expose the patient´s survival. A 43-years old female with mutilant ulceronecrotic lesions with rapid evolution and mucutaneous involvement, is presented. With clinical suspicion of secondary-tertiary syphilis, it was detected reactive serology to HIV infection. The recognition that a large proportion of patients with HIV infection also have syphilis has raised the watchword respect to the interaction between these two diseases.

[Primary syphilitic lesion mimicking penile cancer. Atypical manifestation with an unconventional diagnostic approach]. / Syphilitischer Primäraffekt unter dem Bild eines Peniskarzinoms. Atypische Manifestation mit ungewöhnlichem diagnostischen Weg.

Syphilis is the great imitator in medicine. Correct diagnosis of this disease can be quite difficult nowadays, after years of rare occurrence but current increasing incidence. Atypical manifestations of syphilis are often misinterpreted and lead to incorrect diagnosis and inappropriate therapy. We present the case of a 48-year-old man with recurrent penile ulcers and indurations that would temporarily heal with oral antibiotics. The most recent lesion had lasted longer than 6 weeks. Because of unsuccessful antibiotic and antiseptic treatment, we operated on the patient, suspecting penile cancer. The diagnosis of syphilis was finally performed by histology, with evolving exanthema and positive serological tests in the meantime. This case report is intended to emphasize the increased need to consider syphilis in the differential diagnosis.

Syphilis: the international challenge of the great imitator.

Syphilis is a systemic disease caused by the spirochete Treponema pallidum. The name of this ancient but pervasive infection is proverbial to health care providers. The worldwide recognition of this term, however, argues with the intricacy of the disease in addition to the diagnostic and therapeutic challenges that persistently affect the global control of syphilis up to the present. This article focuses on the varied presentations of the infection, earning the title the "great imitator." The article also tackles other significant concerns regarding this malady.

[The significance of Karol Gilewski (1832-1871) for the Polish laryngology]. / Znaczenie karola gilewskiego (1832-1871) dla polskiej laryngologii.

The professional and scientific activities of Karol Gilewski (1832-1871), one of the famous Cracovian physicians, the professor of the Jagellonian University are described first of all. His treatise on laryngofissure and laryngeal polyps in 1865 is presented widely. This is a second scientific work in Polish medical literature on this subject. The cases of laryngeal scleroma and laryngeal and cutaneous syphilis are also described.

[Syphilis maligna in an HIV-negative patient]. / Syphilis maligna bei einem HIV-negativen Patienten.

A 21-year-old patient with a history of drug addiction presented with generalized, centrally-ulcerated papules and haemorrhagic crusts. Initially, differential diagnostic considerations included pityriasis lichenoides et varioliformis acuta and syphilis. Biopsy and serological testing confirmed the latter diagnosis. Syphilis maligna is a rare form of secondary syphilis; symptoms include a papulonecrotic exanthem and general malaise with fevers and wasting. In the past the disease was described in connection with tuberculosis; today it is most often seen in association with HIV.

Sifilis maligna: presentación previa a seroconversión en HIV / Malignant syphilis: previus presentation a seroconvertion in HIV

La sífilis maligna es una infrecuente forma de sífilis secundaria caracterizada por lesiones nóduloulcerativas destructivas, compromiso del estado general y curso agresivo sin tratamiento. Actualmente se la observa con mayor frecuencia asociada a la inmunodepresión por el virus del sida. Presentamos una paciente de 27 años de edad que desarrolló la enfermedad en forma previa a la seroconversión para HIV

[Good must drive out evil. On cosmetic treatment agents and earlier times' viewpoint on skin diseases]. / Med godt skal ondt fordrives. Om kosmetiske behandlingsmidler og tidligere tiders syn på hudsygdomme.

The interest in skin preparation and "cosmetics" has increased in recent years. This development, which seeks to satisfy the patients' wishes and requirements for a kind but at the same time effective treatment is of historical significance. The treatment of skin diseases was in earlier times pervaded by another attitude, to the effect that evil should drive out evil, e.g. syphilis, scabies and psoriasis. The physician prescribes but it is the patient who executes the treatment, a point more often borne in mind with regard to the diseases of today.