Overlap of psoriasiform and primary syphilis: an atypical manifestation of secondary syphilis (a case report).

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum (T. pallidum) with an increasing incidence in recent years. Secondary syphilis is called 'the great imitator' due to its various clinical presentations. Psoriasiform syphilis is an atypical presentation of secondary syphilis. The coinfection of syphilis with HIV has been linked to more severe clinical presentations increased risk of neurosyphilis, decreased CD4+ count, and an interesting phenomenon of overlapping primary and secondary syphilis. A 35-year-old male presented with generalized thick, scaly erythematous plaques, including the soles of the palms and feet, diffuse alopecia on the scalp and eyebrows, and multiple painless ulcers on the penis. The venereal disease research laboratory and Treponema pallidum hemagglutination assay examination showed positive results and the patient was treated with an intramuscular injection of 2.4 million units of Benzathine penicillin G. At the seventh-day follow-up, the patient showed significant clinical improvement marked by plaque thinning and reduced erythema. This case emphasizes that secondary syphilis may present with varied clinical presentations which can be further affected with HIV coinfection. Detailed history taking, physical examination, and a high level of suspicion are crucial in recognizing and establishing the right diagnosis.

Mucocutaneous mycoses in people living with human immunodeficiency virus in Indonesia.

BACKGROUND: To date, integrated care for people living with human immunodeficiency virus (PLHIV) has improved. However, although the management of mucocutaneous mycosis cases has improved, disease progression might be different in immunocompromised patients, which leads to variable clinical manifestations. OBJECTIVES: To describe the characteristics of mucocutaneous mycosis cases in the PLHIV population and its associated factors in Indonesia. METHODS: This retrospective study was conducted from January 2014 to December 2018 in four academic hospitals. Data were acquired from medical records with the inclusion of mucocutaneous mycosis patients with concurrent HIV infection. Analysis with the chi-squared test was performed using Statistical Package for the Social Sciences (SPSS) version 20.0. RESULTS: A total of 1,796 cases of mucocutaneous mycoses were identified in 1782 PLHIV. The most common types of infection were candidiasis (63%), followed by dermatophytosis (35.1%), and malasseziosis (1.9%), which were significantly higher in PLHIV with CD4 level <200 cells/mm3 . The proportions of male gender (78.6% vs. 56.3%, p < .001), high level of education (48.0% vs. 64.1%, p < .001), office workers (73.8% vs. 64.1%, p < .001), combination of topical and systemic antifungal agents (59.1% vs. 48.5%, p = .006) and not receiving antiretroviral therapy (63.2% vs. 7.8%, p < .001) were significantly higher in PLHIV with a CD4 level <200 cells/mm3 . CONCLUSION: In Indonesia, the most common fungal infection in PLHIV is candidiasis. This study also addressed the important matters regarding mucocutaneous mycoses in PLHIV. Education is an important measure to prevent the incidence of cutaneous mycoses in PLHIV, especially in high-risk groups.

Gonorrhea vaginitis in a pediatric patient: a case report.

Gonorrhea is all diseases caused by Neisseria gonorrhoeae. Prepubertal child is more susceptible to N. gonorrhoeae infection because the vagina is alkaline and contains no estrogen. Gonorrhea vaginitis is the most common form of gonorrhoea in prepubertal children beyond neonatal period. Transmission in child can be through sexual contact (abuse) or non-sexual contact. Gonorrhea vaginitis in children more often asymptomatic, with clinical manifestation such as mucopurulent discharge, vaginal pruritus and vulval erythema. Supporting examination comprise of gram staining from vaginal discharge, culture and nucleic acid amplification testing (NAAT). Ceftriaxone is drug of choice gonorrhea without complication in children. We report a case of 4 year and 9-month female girl that was diagnosed by history taking and supporting examination from gram staining and polymerase chain reaction (PCR) from vaginal discharge, and then treated with single dose ceftriaxone 125 mg intramuscular that gave clinical improvement.

Cutaneous candidiasis caused by Candida kefyr.

Candidiasis is an acute or subacute fungal infection caused by fungi that belongs to candida genus, with Candida albicansbeing the most frequent causative agent. Candida kefyr is a rare cause of candidiasis which has been reported in systemic candidiasis and deep infections. However, to date, it has never been reported as a cause in dermatophytosis. We report a case of candidiasis caused by Candida kefyr in a 72-year-old woman with a chief complaint of pruritic erythematous rash on the back from one day prior to admission. Diagnosis was established based on clinical features, direct microscopic examination with 10% potassium hydroxide solution, gram staining. The fungal species was determined by carbohydrate fermentation test which showed a positive result for Candida kefyr. The patient was treated with miconazole cream and fusidic cream and showed significant clinical improvement.

Successful diagnosis and management of tuberculosis verrucosa cutis using antituberculosis therapy trial approach.

Tuberculosis verrucosa cutis is a paucibacillary form of cutaneous tuberculosis that often occurs in sensitized immunocompetent individuals due to exogenous reinfection. The diagnosis is often difficult because the clinical features are often not typical and acid-fast staining test often shows negative results. Therapeutic trial with antituberculosis therapy is justified if there is strong clinical suspicion in which diagnosis can be made based on the therapeutic response. We report a 46-year-old male with erythematous verrucous plaque on the right knee and crusted erythematous plaque on the left dorsal foot that had been present for 20 years. There were neither history of previous trauma nor tuberculosis treatment. Histopathology, culture, polymerase chain reaction (PCR), Mantoux test, and chest radiograph were negative for cutaneous tuberculosis. Gamma release interferon assay showed positive result. The patient was given category 1 antituberculosis treatment and showed improvement after three weeks. Treatment was continued for 6 months and the lesion significantly regressed.