Erythema nodosum leprosum necroticans: a case report of an atypical severe type 2 leprosy reaction and literature review.

Until now, leprosy remains a problem and challenge in the world because it can cause disability and morbidity in affected individuals, including problems due to the emergence of type 2 lepra reaction or erythema nodosum leprosum (ENL). The clinical picture of ENL can appear in an atypical and severe form, called ENL necroticans (ENN), which becomes a problem in diagnosis and therapy. We report a 17-year-old female with lepromatous leprosy and ENN who received therapy in the form of a combination of steroids and methotrexate. Four months after consuming this therapy, the ulcers on the patient's body improved, leaving atrophic and hypertrophic scars. ENN's unusual clinical presentation poses diagnostic difficulties in that its appearance does not follow the typical patterns, making it challenging to identify correctly. Furthermore, managing cases of ENN may necessitate supplementary treatment beyond steroids alone.

Malignant syphilis: an early feature of underlying HIV infection in an MSM patient.

Introduction: Co-infection of human immunodeficiency virus (HIV) with syphilis is common and has significant clinical consequences. HIV infection can change the course and clinical manifestations of syphilis, resulting in atypical syphilis. A rare feature of this infection is malignant syphilis, which frequently resembles other skin lesions and poses a challenge in diagnosis. This report aims to describe a case of malignant syphilis in an HIV-positive patient. Case report: A 33-year-old man who has sex with men (MSM) came to the dermato-venereology outpatient clinic with chief complaints of ulcerative lesions on the face, trunk, arms, palms, and legs for the past two months. The patient complained of fever, chills, and decreased appetite two weeks prior to presentation. A dermatological examination showed numerous well-demarcated ulcerated plaques and nodules partially covered with crust. Reactive results were found on syphilis serologic tests with high titers. The test for HIV was reactive, with a CD4 cell count of 219 cells/mm3. The patient was then diagnosed with malignant syphilis and received treatment in the form of benzathine penicillin injection 2.4 million units once a week for three consecutive weeks. After treatment, the skin lesions and syphilis serologic titer improved. Conclusions: Secondary syphilis in patients with HIV infection may present as an atypical variant. As reported in this case, malignant syphilis should always be considered in the differential diagnosis when ulcerative and necrotic lesions are observed in individuals with HIV infection.

Impact of pandemic COVID-19 on dermatology and venereology outpatient clinic in a tertiary referral hospital in Yogyakarta, Indonesia.

COVID-19 has spread throughout the world rapidly, including in Indonesia. During this pandemic, there are differences in the number and types of patient cases who attend the dermatology and venereology outpatient clinic. This study aimed to investigate the differences in the number of cases, disease profiles, diagnostic procedures, and therapy procedures before and during the COVID-19 pandemic in the dermatology and venereology outpatient clinic in Dr. Sardjito General Hospital, Yogyakarta, Indonesia. At the beginning of the COVID-19 pandemic, there was a 61.2% decrease in patients visiting outpatient clinic compared to the same period in previous year. There was also a decrease in the number of diagnostic procedures and therapeutic procedures performed in the outpatient clinic. For the disease profile of the total number of patients who visited the outpatient clinic, there was a slight difference. In 2019, the number of cases of acne vulgaris became the second largest, but in 2020, the number of cases of acne vulgaris decreased to the fifth largest. These results support the finding that COVID-19, although not a skin disease, has an impact on dermatology and venereology outpatient clinic.