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.

Modified Non-Cultured Cell Spray Induced Epithelization in LAMB3 Mutation Epidermolysis Bullosa.

Background: Autologous non-cultured cell (ANCC) spray has been used to treat burns, chronic wounds, and vitiligo, but its use in junctional epidermolysis bullosa (JEB) has not been published previously. Chronic wounds in JEB are caused by mutations of laminin 332 (L322), whose function is to attach and act as a glue in the basal membrane. It is proposed that ANCC applications can provide keratinocytes and fibroblasts required to improve epithelization and spontaneously correct revertant keratinocytes in the wound area. Purpose: To develop a modified procedure of ANCC spray and improve epithelization using silver sulfadiazine covered with plastic wrap to treat chronic wounds of JEB. Patients and Methods: Shave excision of the donor site was performed on a 19-year-old girl with JEB. The ANCC spray was prepared and applied to the chronic wound, which was then covered with silver sulfadiazine occluded with plastic wrap. Results: Following the ANCC spray application, epithelization was successfully initiated. Unfortunately, the wounds recurred after four months of follow-up. Conclusion: The modified application method of ANCC spray provides a good alternative to treat chronic wounds in JEB.