RESUMEN
ABSTRACT: Tertiary syphilis may present a diagnostic challenge due to negative nontreponemal serologies in up to 30% of cases and frequent lack of identifiable spirochetes on histopathology or other direct detection tests. We report 2 cases of round bodies staining with Treponema pallidum immunohistochemistry by light microscopy in biopsies from cutaneous syphilitic gummata. In 1 case, the finding was validated 3 times by 2 independent laboratories; in the other case, T. pallidum was detected by polymerase chain reaction in the biopsy sample. Spirochete round bodies have previously been reported in the setting of electron microscopy and fluorography, but to the best of our knowledge, have not been reported by light microscopy in a routine skin biopsy. Although the clinical implications are unclear, this may represent a helpful new paradigm for the diagnosis of tertiary syphilis.
Asunto(s)
Sífilis Cutánea , Sífilis , Humanos , Treponema pallidum , Sífilis Cutánea/diagnóstico , Sífilis Cutánea/patología , Colorantes , Sífilis/diagnóstico , Sífilis/patologíaRESUMEN
We describe a 17-year-old man who developed penile annular and scrotal eczematoid syphilids with penile chancre redux. Dermoscopy showed linear-irregular and hairpin vessels with white scales in annular lesions. Histopathology displayed psoriasiform hyperplasia with perivascular lymphoplasmacytic dermal infiltrate. Rapid plasma reagin and Treponema pallidumparticle agglutination assays were positive. The lesions disappeared after intramuscular benzathine penicillin.
Asunto(s)
Chancro/patología , Sífilis Cutánea/patología , Adolescente , Antibacterianos/uso terapéutico , Chancro/diagnóstico por imagen , Chancro/tratamiento farmacológico , Dermoscopía , Humanos , Masculino , Penicilina G Benzatina/uso terapéutico , Pene/diagnóstico por imagen , Pene/patología , Escroto/diagnóstico por imagen , Escroto/patología , Sífilis Cutánea/diagnóstico por imagen , Sífilis Cutánea/tratamiento farmacológico , Resultado del TratamientoAsunto(s)
Sífilis , Humanos , Masculino , Sífilis/diagnóstico , Sífilis/tratamiento farmacológico , Sífilis/microbiología , Treponema pallidum/aislamiento & purificación , Antibacterianos/uso terapéutico , Resultado del Tratamiento , Adulto , Sífilis Cutánea/tratamiento farmacológico , Sífilis Cutánea/diagnóstico , Sífilis Cutánea/microbiología , Sífilis Cutánea/patología , Serodiagnóstico de la Sífilis , Biopsia , Piel/patología , Piel/microbiologíaRESUMEN
Condyloma lata, a cutaneous manifestation of secondary syphilis, usually appear as verrucous papules and plaques in the anogenital area. Involvement of the umbilicus is very uncommon. Thus, awareness of this presentation, along with appropriate history, physical exam, and laboratory testing may aid clinicians in prompt and accurate diagnosis. We describe a patient with an unusual presentation of condyloma lata on the umbilicus.
Asunto(s)
Sífilis Cutánea/diagnóstico , Sífilis/diagnóstico , Adulto , Humanos , Masculino , Sífilis/tratamiento farmacológico , Sífilis/patología , Sífilis Cutánea/tratamiento farmacológico , Sífilis Cutánea/patología , OmbligoRESUMEN
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.
Asunto(s)
Antibacterianos/uso terapéutico , Doxiciclina/uso terapéutico , Piel/microbiología , Sífilis Cutánea/patología , Sífilis/patología , Neoplasias Testiculares/patología , Testículo/patología , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Orquiectomía , Piel/patología , Sífilis/terapia , Sífilis Cutánea/terapia , Neoplasias Testiculares/cirugía , Testículo/microbiología , Resultado del TratamientoRESUMEN
In infectious pathology, the gold standard consists of the detection of the pathogen within the sample. Identification of the pathogen is often difficult despite the presence of few and inexpensive tools, such, as special stain, immunohistochemistry, or in situ hybridization specific of the pathogen. In infectious pathology, there are morphological signs, which can guide us towards an etiology. We present some clinicopathological examples illustrating rare or unusual situations in cutaneous infectious pathology.
Asunto(s)
Patólogos , Patología/métodos , Enfermedades Cutáneas Infecciosas/patología , Anciano de 80 o más Años , Diagnóstico Diferencial , Epidermodisplasia Verruciforme/diagnóstico , Epidermodisplasia Verruciforme/patología , Dermatosis Facial/diagnóstico , Dermatosis Facial/patología , Femenino , Infecciones por VIH/complicaciones , Dermatosis de la Mano/diagnóstico , Dermatosis de la Mano/patología , Humanos , Inmunohistoquímica/métodos , Hibridación in Situ/métodos , Linfoma no Hodgkin/diagnóstico , Masculino , Persona de Mediana Edad , Infestaciones por Ácaros/diagnóstico , Infestaciones por Ácaros/patología , Rol del Médico , Enfermedades Cutáneas Infecciosas/diagnóstico , Coloración y Etiquetado/métodos , Sífilis Cutánea/diagnóstico , Sífilis Cutánea/patologíaRESUMEN
As evidenced by the Centers for Disease Control and Prevention (CDC) statistics, syphilis is yet again on the rise. It is known as the great mimicker because of its variable symptoms and how frequently it can be confused with other diseases. The different stages of syphilis (primary, secondary, latent, late latent and tertiary) are discussed. We describe a new histopathologic pattern of syphilis, one that mimics connective tissue disease and can represent a diagnostic pitfall. In this time and age, when syphilis is rising especially among the men who have sex with men subgroup, it is important to keep a high index of suspicion of syphilis even when clinically and histopathologically the findings on first glance may not appear characteristic.
Asunto(s)
Sífilis Cutánea/diagnóstico , Sífilis Cutánea/patología , Adulto , Humanos , MasculinoAsunto(s)
Canal Anal , Condiloma Acuminado/diagnóstico , Sífilis Cutánea/diagnóstico , Sífilis/diagnóstico , Treponema pallidum/aislamiento & purificación , Adulto , Canal Anal/microbiología , Canal Anal/patología , Canal Anal/cirugía , Diagnóstico Diferencial , Humanos , Masculino , Valor Predictivo de las Pruebas , Sífilis/microbiología , Sífilis/patología , Sífilis/cirugía , Sífilis Cutánea/microbiología , Sífilis Cutánea/patología , Sífilis Cutánea/cirugíaRESUMEN
We present a 36-year-old HIV-positive man with a sixweek history of spreading, ulcerative, and necroticcutaneous lesions. Laboratory and histopathologicexamination revealed syphilis. This case of malignantsyphilis, also known as lues maligna, is an uncommonvariant of this sexually transmitted infection. This casehighlights the importance of including malignantsyphilis in the differential diagnosis of patientspresenting with a disseminated ulcerative andnecrotic rash, especially in individuals with HIV.
Asunto(s)
Infecciones por VIH/complicaciones , Úlcera Cutánea/diagnóstico , Piel/patología , Sífilis Cutánea/diagnóstico , Adulto , Humanos , Masculino , Necrosis , Úlcera Cutánea/etiología , Úlcera Cutánea/patología , Sífilis Cutánea/complicaciones , Sífilis Cutánea/patologíaRESUMEN
BACKGROUND: Secondary syphilis has a wide spectrum of clinical and histologic manifestations. OBJECTIVE: We sought to determine the frequency of histopathological features characterizing secondary syphilis, and which are most common in specimens displaying few diagnostic findings. METHODS: In a multicenter, retrospective analysis of biopsy-proven secondary syphilis, cases were subcategorized by the number of histologic characteristics present. RESULTS: The 106 cases mostly had 5 to 7 of the features studied. Many features were scarcer in cases with 5 or fewer features, including endothelial swelling (87.7% overall vs 72.4% ≤5 features), plasma cells (69.8% vs 48.3%), and elongated rete ridges (75.5% vs 27.6%). Specimens with 5 or fewer features were more likely to be truncal (61.1% vs 34.4% overall), demonstrate rete ridge effacement (44.8% vs 19.8%), and have pityriasis rosea (33.3% vs 17.2%) or drug eruption (33.3% vs 10.9%) in the clinical differential. An interstitial inflammatory pattern was the most common characteristic of specimens with 5 or fewer features (75.9%). LIMITATIONS: This was a retrospective review. CONCLUSION: The independent value of many histologic features of syphilis may be overestimated. Combinations of endothelial swelling, interstitial inflammation, irregular acanthosis, and elongated rete ridges should raise the possibility of syphilis, along with the presence of vacuolar interface dermatitis with a lymphocyte in nearly every vacuole and lymphocytes with visible cytoplasm.
Asunto(s)
Sífilis Cutánea/epidemiología , Sífilis Cutánea/patología , Sífilis/epidemiología , Sífilis/patología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Biopsia con Aguja , Estudios de Cohortes , Femenino , Humanos , Inmunohistoquímica , Incidencia , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Enfermedades de Transmisión Sexual/prevención & control , Estados Unidos/epidemiología , Adulto JovenAsunto(s)
Pie/patología , Mano/patología , Sífilis Cutánea , Adulto , Femenino , Humanos , Sífilis Cutánea/diagnóstico , Sífilis Cutánea/patología , Adulto JovenRESUMEN
Malignant syphilis is a rare ulcerative variety. In the classical description of the disease, the absence of spirochetes in tissue samples was considered as a diagnostic criterion. We report 3 cases of malignant syphilis; in all of them, spirochetes were identified in cutaneous biopsy samples using immunohistochemical staining.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/patología , Antibacterianos/administración & dosificación , Penicilina G Benzatina/administración & dosificación , Sífilis Cutánea/patología , Treponema pallidum/aislamiento & purificación , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Adulto , Recuento de Linfocito CD4 , Humanos , Inmunohistoquímica , Inyecciones Intramusculares , Masculino , Índice de Severidad de la Enfermedad , Sífilis Cutánea/tratamiento farmacológico , Sífilis Cutánea/inmunología , Resultado del Tratamiento , Carga ViralRESUMEN
A 62-year-old male presented with a 10-day history of a diffuse, erythematous papular rash sparing the palms and soles. Histopathologic examination of a skin lesion showed loose non-caseating granulomas in a lymphoplasmacytic background. Scattered spirochetes were identified by Treponema pallidum immunohistochemistry, in keeping with a diagnosis of secondary syphilis. Granulomatous inflammation in secondary syphilis is uncommon. A review of the literature reveals that the majority of prior reported cases of granulomatous secondary syphilis share similar characteristics to this case; namely, a papular or nodular clinical presentation, sparing of the palms and soles, and collections of epithelioid histiocytes with associated lymphocytes and variable numbers of plasma cells.
Asunto(s)
Piel/patología , Sífilis Cutánea/patología , Sífilis/patología , Treponema pallidum , Humanos , Inflamación/microbiología , Inflamación/patología , Masculino , Persona de Mediana Edad , Piel/microbiología , Sífilis/microbiología , Sífilis Cutánea/microbiologíaAsunto(s)
Dendritas , Melanocitos , Piel , Sífilis Cutánea , Treponema pallidum , Dendritas/metabolismo , Dendritas/patología , Humanos , Inmunohistoquímica , Melanocitos/metabolismo , Melanocitos/patología , Piel/metabolismo , Piel/patología , Sífilis Cutánea/metabolismo , Sífilis Cutánea/patologíaAsunto(s)
Infecciones por VIH , VIH-1 , Sífilis Cutánea , Vasculitis Leucocitoclástica Cutánea , Adulto , Infecciones por VIH/metabolismo , Infecciones por VIH/microbiología , Infecciones por VIH/patología , Humanos , Masculino , Sífilis Cutánea/metabolismo , Sífilis Cutánea/patología , Sífilis Cutánea/virología , Vasculitis Leucocitoclástica Cutánea/metabolismo , Vasculitis Leucocitoclástica Cutánea/microbiología , Vasculitis Leucocitoclástica Cutánea/patología , Vasculitis Leucocitoclástica Cutánea/virologíaAsunto(s)
Eritema/patología , Neoplasias Cutáneas/patología , Úlcera Cutánea/patología , Sífilis Cutánea/patología , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Exantema/etiología , Humanos , Inyecciones Intramusculares , Linfadenopatía/etiología , Linfadenopatía/patología , Masculino , Penicilina G Benzatina/administración & dosificación , Penicilina G Benzatina/uso terapéutico , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/microbiología , Enfermedades de Transmisión Sexual/patología , Sífilis Cutánea/tratamiento farmacológico , Sífilis Cutánea/microbiología , Tonsilitis/diagnóstico , Tonsilitis/etiología , Resultado del Tratamiento , Treponema pallidum/aislamiento & purificación , Adulto JovenRESUMEN
Syphilis is an ancient sexually transmitted infection that plagues communities across the United States and the world. Cutaneous syphilis has a wide variety of manifestations and presentations, and is notoriously difficult to identify clinically as a result. In this report, we describe the case of a 30-year-old patient with condyloma lata on the umbilicus, an extremely rare site for the presentation of these lesions. With the recent surge in syphilis infections nationwide, including congenital infections, this case underscores the urgent necessity for heightened syphilis awareness and suspicion among clinicians.