1/10. Syphilitic uveitis as the initial manifestation of hiv infection.syphilis is an uncommon cause of uveitis in hiv-infected patients. We report a case of bilateral panuveitis and describe its characteristics as the initial manifestation of hiv infection. A 74-year-old heterosexual male complained of blurred vision and floaters in both eyes for 40 days. Slit lamp examination showed diffuse keratic precipitates and cells in the anterior chamber of both eyes. Fundus examination revealed multiple small white dots and scattered retinal hemorrhage over the mid-equatorial retina with marked vitritis. physical examination disclosed multiple erythematous papules over bilateral palms compatible with secondary syphilis. serologic tests--the venereal disease research laboratory (VDRL) test, fluorescent treponemal antibody absorption (FTA-ABS) test, and treponema pallidum hemagglutination (TPHA) test--were all positive. Aqueous fluid also showed positive FTA-ABS reaction. Under the impression of acquired secondary syphilis, enzyme-linked immunosorbent assay and Western blot test were performed and revealed concurrent hiv infection. After intravenous administration of penicillin-G, 18 million units daily for 2 weeks, the vitritis and retinochoroiditis improved. All patients with panuveitis of unknown cause should undergo VDRL and FTA-ABS screening. Subsequent testing for hiv antibody in leutic uveitis is also mandatory.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
2/10. With this eruption, there is not a second to lues.A 28-year-old white man presented to the Emergency Department with a 24-hour history of an eruption on his extremities, trunk, and face. The patient was known to be hiv positive with a CD4 count of 527 and a viral load of 20,300. He denied fever, chills, malaise, and headache. His social history was significant for the fact that he was in a monogamous homosexual relationship. He had no recent travel, pet exposures, or sick contacts. physical examination revealed stable vital signs and no documented fever. A maculopapular eruption was present on his face, trunk, and extremities (Figures 1 and 2). There was no palmar or plantar involvement. He was treated with diphenhydramine and topical 2.5% hydrocortisone and advised to return if his condition did not improve. Twelve days after the initial evaluation, the patient consulted us again due to progression of his dermatitis. He had no additional complaints other than an eruption on both palms but neither sole. (Figure 3). The eruption now demonstrated erythematous pink-red oval macules and papules 1-2 cm in size distributed on his scalp, face, trunk, and arms. A few papules contained fine collarettes of scale. Further questioning revealed that the patient had experienced a tender rectal ulcer 2 months previously. A punch biopsy and rapid plasma reagin were performed. The histopathologic examination revealed interface dermatitis with lymphocytes, plasma cells, occasional neutrophils, and a prominent lymphoplasmacytic perivascular dermatitis with infiltration of the vessel walls. Warthrin-Starry and Steiner methods demonstrated spirochetes at the dermal-epidermal junction and in vessel walls, consistent with treponema pallidum (Figure 4). Rapid plasma reagin and fluorescent Treponema antibody were both reactive with a Venereal disease research Laboratory (VDRL) of 1:16. The patient was diagnosed as having secondary syphilis and treated with 2.4 million units of IM benzathine penicillin for 3 weeks. His eruption resolved after the initial treatment and he did not experience a Jarisch-Herxheimer reaction.- - - - - - - - - - ranking = 2keywords = palm (Clic here for more details about this article) |
3/10. psoriasis guttata with palmoplantar involvement clinically mimicking secondary syphilis.Papulosquamous eruptions involving the palms and soles are thought to be particularly suggestive of secondary syphilis. Alternative diagnoses exist, however, and include psoriasis guttata, atypical pityriasis rosea, and pityriasis lichenoides chronica (PLC). We describe the case of a patient with an abrupt onset of psoriasis guttata and extensive palmoplantar involvement. Results of serologic testing were negative for treponemicidal antibodies. Results of histopathologic examination demonstrated psoriasiform dermatitis with neutrophils in the epidermis; plasma cells were absent. Spirochetes were not demonstrated in a tissue sample using silver or immunohistochemical stains for treponema pallidum. A broad differential diagnosis is required when evaluating papulosquamous eruptions with palmoplantar involvement. Although not well referenced in the medical literature, psoriasis guttata can indeed cause palmoplantar lesions that mimic those of secondary syphilis.- - - - - - - - - - ranking = 8keywords = palm (Clic here for more details about this article) |
4/10. Neuroretinitis in secondary syphilis.A 30-year-old man with bilateral neuroretinitis and uveitis associated with secondary syphilis is described. Characteristic lesions on the palms of the hands and the soles of the feet gave us the clue to the diagnosis. Treatment with penicillin resulted in a rapid cure. Syphilic neuroretinitis is often associated with secondary meningitis. early diagnosis and adequate therapy are important in this serious but treatable condition.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
5/10. iridocyclitis and an iris mass associated with secondary syphilis.A 34-year-old white man developed iridocyclitis and an iris mass. The iridocyclitis was preceded by a nodular rash which spared the palms and soles. An anterior segment fluorescein angiogram was performed which showed numerous permeable vessels. An ultrasound examination of the mass showed that it extended to the ciliary body. He had both a positive RPRCT and FTA-Abs. A skin biopsy was done which disclosed the nodules to be a rare form of secondary syphilis. The patient was treated with topical steroids and a cycloplegic agent, and later prednisone and intravenous penicillin, with eventual resolution of iris mass, iridocyclitis and skin nodules.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
6/10. ampicillin allergy presenting as secondary syphilis.This article reports a case of ampicillin rash with oral and skin lesions, including lesions on the palms and the soles. The distribution of the lesions in a young, sexually active man was suggestive of secondary syphilis. The history, the nature of the delayed rash of ampicillin, and the treatment are reviewed.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
7/10. Secondary syphilitic uveitis.A patient with secondary syphilis had positive serum and cerebrospinal fluid findings. Fluorescent-antibody darkfield testing demonstrated spirochetes (treponema pallidum) in the aqueous. There were clinical signs of secondary syphilis, including palmar skin lesions and frontal balding, and bilateral nasal altitudinal visual field loss. The discrete, waxy, yellow-white retinal lesions became increasingly pigmented and later migrated anteriorly into the vitreous chamber. The patient was treated with large amounts of penicillin (total dosage, 440 million units) and probenecid. visual acuity improved to R.E. : 6/9 (20/30) and L.E.: 6/12 (20/40) and the inflammatory reaction disappeared. A second aqueous tap eight weeks after therapy ended showed no spirochetes by fluorescent-antibody testing.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
8/10. syphilis d'emblee due to blood transfusion. Case report.A 58-year-old Chinese woman presented with syphilis d'emblee. Seven weeks after a blood transfusion lesions appeared on the palms of her hands and the soles of her feet. These gradually increased in number and other lesions developed on the scalp and palatal mucosa. One of the blood donors was found to have had positive serological test results for syphilis but no clinical symptoms or signs. This case illustrates the danger inherent in the use of whole fresh blood for transfusion purposes.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
9/10. An unusual presentation of secondary syphilis in the northern territory.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.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
10/10. Preschoolers with syphilis.syphilis in preschoolers is rarely described in current medical literature, despite the rise in syphilis in both the adult and the pediatric populations during the past decade. Since that time, 3 children between 3 and 4 years of age have been diagnosed with syphilis at the Children's Hospital of philadelphia. The presentations and clinical manifestations of syphilis in these 3 children are described, and the difficulty in identifying the source of infection is discussed. The presentations of these children included nephrosis and secondary syphilis, the corymbiform and palmar rash of syphilis, and subtle signs of late congenital infection in an otherwise asymptomatic child. One child had documented congenital infection, 1 had probable congenital infection that went untreated, and 1 did not have appropriate neonatal testing documented. None of the children gave a verbal history of sexual abuse, although it is likely that all three cases resulted from sexual abuse. The evaluation of preschool children with syphilis is confounded by the interpretation of acquired infection in consideration of a history of possible or documented congenital disease. The assessment is complicated further by problems with recognition of clinical disease, the inability of young children to provide a history, prenatal and neonatal testing methods used, changes in treatment recommendations made during the past decade, and inadequate follow-up to document cure of congenitally infected infants. With the increase in syphilis seen in recent years, physicians are more likely to encounter preschoolers with syphilis. Our ability to document acquired infection, however, is hampered by the difficulties encountered in following recommended guidelines for evaluation and follow-up and by limitations in interviewing young victims of sexual abuse, which may impair our ability to protect children from additional harm. Understanding the pathophysiology and progression of this disease remains challenging even in this modern era.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
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