ABSTRACT
La sífilis maligna es una forma infrecuente de sífilis secundaria asociada a la infección por el VIH, caracterizada clínicamente por nódulos necróticos y lesiones ulceradas generalizadas. Presentamos 4 pacientes diagnosticados de sífilis maligna tras revisar los casos de sífilis diagnosticados en nuestro centro entre 2012 y 2016. Describimos los aspectos epidemiológicos, clínicos, histopatológicos y serológicos, así como su relación con el VIH y la respuesta al tratamiento. Aunque se trate de una forma de sífilis poco frecuente, en los últimos años ha aumentado el número de casos publicados, principalmente pacientes jóvenes infectados por el VIH. Es necesario incluir la sífilis maligna en el diagnóstico diferencial de pacientes infectados por el VIH con lesiones ulceradas y necróticas
Malignant syphilis is an uncommon form of secondary syphilis associated with HIV infection. Clinically, it is characterized by necrotic nodules and generalized ulcerated lesions. We present 4 cases of malignant syphilis diagnosed after evaluating syphilis cases diagnosed at our hospital between 2012 and 2016. We describe the epidemiologic, clinical, histiopathologic, and serologic characteristics of malignant syphilis and explore its response to treatment and association with HIV infection. Although malignant syphilis is uncommon, there has been an increase in the number of cases published in recent years, particularly in young HIV-positive patients. Malignant syphilis must be contemplated in the differential diagnosis of HIV patients with ulcerated, necrotic lesions
Subject(s)
Humans , Male , Adult , Middle Aged , HIV Infections/complications , Syphilis, Cutaneous/epidemiology , Syphilis, Cutaneous/etiology , Skin Ulcer/pathology , Syphilis/complications , HIV Infections/epidemiology , Diagnosis, Differential , Retrospective Studies , Scalp/pathologyABSTRACT
The ongoing human immunodeficiency virus (HIV) infection epidemic coupled with more efficacious and available treatments has led to a larger number of patients living with HIV or AIDS. As a result, skin manifestations related to HIV/AIDS or its therapy have become increasingly more common and are reported to occur in as many as 95% of patients. Herein, we review the most common HIV/AIDS related cutaneous pathologies and classify them into inflammatory, HAART-associated, neoplastic, and infectious manifestations. Cutaneous manifestations should be promptly recognized and treated by physicians and health care personnel in order to provide optimal care.
Subject(s)
AIDS-Related Opportunistic Infections/etiology , Acquired Immunodeficiency Syndrome/complications , Skin Diseases, Infectious/etiology , Skin Neoplasms/etiology , AIDS-Related Opportunistic Infections/drug therapy , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/etiology , Angiomatosis, Bacillary/etiology , Anti-Retroviral Agents/adverse effects , Antiretroviral Therapy, Highly Active/adverse effects , Dermatitis, Seborrheic/etiology , Humans , Psoriasis/etiology , Sarcoma, Kaposi/etiology , Sarcoma, Kaposi/pathology , Skin Diseases, Infectious/physiopathology , Skin Neoplasms/pathology , Syphilis, Cutaneous/etiologyABSTRACT
We present a 47 year old female white HIV-1 infected patient with multiple painless rupioid skin lesions, a CD4 count of 155 cells/mm3, positive syphilis serology and a histopathology conspicuous for malignant syphilis. She could be successfully treated with Benzathine-Benzylpenicillin (Retarpen®) 2,4 Mega I.E., 3x intramuscularly in weekly intervals.
Subject(s)
Anti-Bacterial Agents/administration & dosage , HIV Infections/immunology , HIV-1/immunology , Penicillin G Benzathine/administration & dosage , Syphilis, Cutaneous/drug therapy , Blotting, Western , CD4 Lymphocyte Count , Drug Administration Schedule , Female , HIV Infections/complications , Humans , Middle Aged , Syphilis, Cutaneous/etiology , Syphilis, Cutaneous/immunology , Treatment Outcome , Viral LoadABSTRACT
The ongoing human immunodeficiency virus (HIV) infection epidemic coupled with more efficacious and available treatments has led to a larger number of patients living with HIV or AIDS. As a result, skin manifestations related to HIV/AIDS or its therapy have become increasingly more common and are reported to occur in as many as 95% of patients. Herein, we review the most common HIV/AIDS related cutaneous pathologies and classify them into inflammatory, HAART-associated, neoplastic, and infectious manifestations. Cutaneous manifestations should be promptly recognized and treated by physicians and health care personnel in order to provide optimal care.
La epidemia del virus de la inmunodeficiencia humana (VIH) sumado al mayor acceso a terapias antiretrovirales (TARV) han llevado a un aumento del número y la sobrevida de pacientes que viven con esta infección crónica. Se estima que hasta 95% de los pacientes con infección por VIH/SIDA presentarán alguna manifestación cutánea, por lo cual, debemos conocerlas. En la presente revisión se estudiarán las manifestaciones cutáneas de la infección por el VIH/SIDA clasificadas como: manifestaciones inflamatorias, manifestaciones asociadas a la TARV, manifestaciones neoplásicas y manifestaciones infecciosas asociadas a infección por VIH/SIDA (bacterianas, virales, fúngicas y parasitarias). Estas manifestaciones deben ser reconocidas por los médicos y el personal de salud a cargo del tratamiento y control de los pacientes con esta patología crónica.
Subject(s)
Humans , AIDS-Related Opportunistic Infections/etiology , Acquired Immunodeficiency Syndrome/complications , Skin Diseases, Infectious/etiology , Skin Neoplasms/etiology , AIDS-Related Opportunistic Infections/drug therapy , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/etiology , Angiomatosis, Bacillary/etiology , Anti-Retroviral Agents/adverse effects , Antiretroviral Therapy, Highly Active/adverse effects , Dermatitis, Seborrheic/etiology , Psoriasis/etiology , Sarcoma, Kaposi/etiology , Sarcoma, Kaposi/pathology , Skin Diseases, Infectious/physiopathology , Skin Neoplasms/pathology , Syphilis, Cutaneous/etiologySubject(s)
Acquired Immunodeficiency Syndrome/drug therapy , Syphilis, Cutaneous/diagnosis , Syphilis/diagnosis , Adult , Anti-HIV Agents/therapeutic use , Humans , Immunocompromised Host , Male , Severity of Illness Index , Syphilis/etiology , Syphilis/physiopathology , Syphilis, Cutaneous/etiology , Syphilis, Cutaneous/physiopathologySubject(s)
Entamoebiasis/etiology , Hepatitis B/etiology , Homosexuality, Male , Syphilis, Cutaneous/etiology , Unsafe Sex , Acute Disease , Anti-Infective Agents/therapeutic use , Antiprotozoal Agents/therapeutic use , Antiviral Agents/therapeutic use , Colonoscopy , Entamoebiasis/diagnosis , Entamoebiasis/drug therapy , Entamoebiasis/pathology , Gastrointestinal Hemorrhage/etiology , Hepatitis B/diagnosis , Hepatitis B/drug therapy , Hepatitis B/pathology , Hepatitis B Surface Antigens/blood , Hepatitis B virus/immunology , Humans , Immunoglobulin M/blood , Jaundice/etiology , Lamivudine/therapeutic use , Male , Metronidazole/therapeutic use , Middle Aged , Penicillins/therapeutic use , Rectum , Syphilis Serodiagnosis , Syphilis, Cutaneous/diagnosis , Syphilis, Cutaneous/drug therapy , Syphilis, Cutaneous/pathologyABSTRACT
BACKGROUND: Lues maligna (also known as malignant syphilis or ulceronodular syphilis) is a rare dermatologic manifestation of syphilis more commonly seen in patients with HIV infection. The classic lesion of lues maligna is an oval, papulopustular skin lesion with well demarcated borders sometimes covered with a lamellar crust, but myriad clinical presentations of this disease also exist. GOALS: To report a presentation of lues maligna in a patient with probable early HIV infection, emphasizing the diagnostic criteria and clinical manifestations of lues maligna. STUDY DESIGN: Case report of lues maligna in a patient with probable early HIV infection. CONCLUSIONS: As syphilis becomes more common in many developed regions, it is important to recognize even atypical presentations of this clinical entity, especially among individuals who have unrecognized or early HIV infection.
Subject(s)
AIDS-Related Opportunistic Infections , HIV Infections/complications , Syphilis, Cutaneous , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/etiology , AIDS-Related Opportunistic Infections/pathology , Adult , Humans , Male , Skin/pathology , Syphilis Serodiagnosis , Syphilis, Cutaneous/diagnosis , Syphilis, Cutaneous/etiology , Syphilis, Cutaneous/pathology , Time Factors , Treponema pallidumSubject(s)
Dermatitis/microbiology , Eye Infections, Bacterial , Syphilis/etiology , Uveitis/microbiology , Adult , Dermatitis/drug therapy , Dermatitis/pathology , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/etiology , Eye Infections, Bacterial/pathology , Humans , Infusions, Intravenous , Male , Penicillin G/therapeutic use , Penicillins/therapeutic use , Syphilis/drug therapy , Syphilis/pathology , Syphilis, Cutaneous/drug therapy , Syphilis, Cutaneous/etiology , Syphilis, Cutaneous/pathology , Uveitis/drug therapy , Uveitis/pathologySubject(s)
Chancre/drug therapy , Penicillin G Benzathine/adverse effects , Penicillins/adverse effects , Penile Diseases/etiology , Syphilis, Cutaneous/etiology , Adolescent , Chancre/pathology , Fever/etiology , Humans , Male , Penicillin G Benzathine/therapeutic use , Penicillins/therapeutic use , Penile Diseases/pathology , Syphilis Serodiagnosis , Syphilis, Cutaneous/pathology , Ulcer/etiology , Ulcer/pathologyABSTRACT
OBJECTIVE: To present a case which demonstrates the unusual clinical features of secondary syphilis that may be encountered in tropical Australia. CLINICAL FEATURES: A syphilitic aetiology was initially missed in a Caucasian female presenting with a rare form of syphilis, "lues maligna", characterised by nodulo-ulcerative skin lesions, fever, meningism and a relapsing course. CONCLUSION: Secondary syphilis is usually manifest in the Northern Territory by a characteristic palmo-plantar psoriasiform eruption with variable involvement of skin in other body areas. The disease is most commonly seen in the young adult Aboriginal population. However, atypical presentations can occur and vigilance must be maintained for a syphilitic aetiology in unusual skin lesions. The disease may produce significant individual morbidity and may be transmitted non-venereally to close contacts in the secondary stage. Genital lesions facilitate the transmission of HIV, making early diagnosis and treatment even more important.
Subject(s)
Syphilis/diagnosis , Adult , Female , Humans , Northern Territory , Syphilis/complications , Syphilis, Cutaneous/diagnosis , Syphilis, Cutaneous/etiologyABSTRACT
We present a case of a patient infected with the human immunodeficiency virus who developed syphilis manifested by atypical early oral and skin ulcerations. The profound immune defects associated with human immunodeficiency virus may lead to an altered clinical presentation and a more aggressive course in patients infected with Treponema pallidum. The unusual clinical manifestations observed in this case emphasize the importance of considering secondary syphilis in the differential diagnosis of any inflammatory mucosal and skin disorder in patients with the human immunodeficiency virus.
Subject(s)
AIDS-Related Opportunistic Infections/diagnosis , Mouth Diseases/diagnosis , Syphilis/diagnosis , Adult , Humans , Male , Mouth Diseases/etiology , Mouth Mucosa/microbiology , Mouth Mucosa/pathology , Syphilis/etiology , Syphilis, Cutaneous/diagnosis , Syphilis, Cutaneous/etiology , Treponema pallidum/isolation & purificationABSTRACT
To identify the characteristic features of lues in patients infected with HIV, 402 HIV-positive patients were examined for serological and clinical signs of lues. 141 patients (133 male, 8 female, mean age 36 [18-69] years) had a positive lues serology. Treatment for lues was required in 20 of the 141 cases (14%). In ten patients (one case of lues I, nine cases of lues II) dermatological signs were predominant, macular exanthemas (n = 4) and palmo-plantar syphilides (n = 3) being most frequent. Three patients had seropositive latent lues. Eight patients presented with signs of an active neurolues (lues II: n = 1; lues III: n = 6; lues IV: n = 1). In three of the eight cases the serum FTA-ABS-IgM findings were negative. In these three patients the need for a specific treatment was realized only on the basis of cerebrospinal fluid (CSF) examination in conjunction with the clinical findings and the anamnesis. This result makes it very clear that indication for CSF puncture should be more liberal in some HIV infected patients. The markedly high proportion of cases of neurolues (40% of the luetic patients requiring treatment) is possibly due to reactivation of old lues infections.