Cases reported "Syphilis"

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1/17. syphilis in an HIV infected patient misdiagnosed as leprosy.

    A 42-year-old man with uveitis and a widespread cutaneous eruption, histopathologically characterized by dermal granulomatous infiltrates with perineurial invasion, was incorrectly diagnosed and treated as having borderline leprosy. Further studies demonstrated secondary syphilis and human immunodeficiency virus (HIV) infection. Standard penicillin therapy resolved his cutaneous and ocular lesions. Reports on clinical and pathological findings of active syphilis in HIV infected patients are scarce but this case and isolated previous case reports suggest that granulomatous infiltrates might be a common feature in secondary syphilis with short evolution in HIV infected patients.
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keywords = eruption
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2/17. Unusual presentation of secondary syphilis in 2 hiv-1 positive patients.

    Due to diverse clinical and histopathological presentations, diagnosis of secondary syphilis can occasionally prove challenging. This is especially true in the setting of human immunodeficiency virus (HIV) infection. Variable clinical presentations of secondary syphilis in HIV disease may result in an incorrect diagnosis and an inappropriate treatment regimen. Similarly, the histology of secondary syphilitic lesions may show considerable variation, depending on the clinical morphology of the eruption. We report 2 cases of secondary syphilis in hiv-1-infected patients with cutaneous lesions of variable clinical presentation and an unusual lymphoid infiltrate simulating mycosis fungoides.
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3/17. Lues and lupus: syphilis mimicking systemic lupus erythematosus (SLE).

    Malar rash and photosensitivity are common findings in systemic lupus erythematosus (SLE). However, a number of inflammatory, dermatologic, infectious or drug-induced conditions may mimic cutaneous findings of SLE. These typically include seborrheic dermatitis, contact dermatitis, rosacea, polymorphous light eruption, syphilis and dermatomyositis sine myositis. Herein we describe a patient with fever, malar rash, alopecia, photosensitivity, arthralgias and lymphadenopathy who was subsequently diagnosed with secondary syphilis. In this case report we review clinical and histopathological findings in the differential diagnosis of malar rash and photosensitivity and discuss the overlapping features of syphilis and SLE.
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keywords = eruption
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4/17. 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.
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ranking = 9
keywords = eruption
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5/17. 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.
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ranking = 2
keywords = eruption
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6/17. Vesicular Jarisch-Herxheimer reaction.

    The Jarisch-Herxheimer reaction is a self-limited, febrile episode that may occur following antibiotic therapy for syphilis. We report four cases of a heretofore unrecognized vesicular variant of the Jarisch-Herxheimer reaction. It is important to distinguish this phenomenon from an allergic drug eruption.
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ranking = 1
keywords = eruption
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7/17. Secondary syphilis of the tonsil.

    An 18-year-old man with an ulceration of his right tonsil and cervical lymphadenopathy was examined. The patient also had a papular eruption in his face, chest, abdomen, and upper extremities. There were no signs of genital involvement. Routine serological tests for syphilis were reactive and histological findings of a cervical lymph node biopsy were characteristic for syphilitic lymphadenitis. Spirochetes were also identified in the tissue sections. A diagnosis of secondary syphilis of the tonsil with cervical syphilitic lymphadenitis was made. In recent years, the number of new cases of syphilis has increased in japan. Since the oral cavity is the most common extragenital site of syphilis, clinicians should bear in mind that oral lesions from an unknown cause might possibly be syphilitic.
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keywords = eruption
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8/17. Pustular acneiform secondary syphilis.

    A patient with a generalized acne-like skin eruption on the trunk, extremities, and face is described. Examination of a skin biopsy specimen revealed syphilis as did positive results of serologic tests. physicians should be aware of this type of secondary syphilis.
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keywords = eruption
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9/17. A case of secondary syphilis with a solitary pulmonary lesion.

    This study describes a case of secondary syphilis with a papular eruption and penile ulceration. A chest roentgenogram showed a solitary lesion in the left middle lung field. Histological examination revealed epithelioid cell granuloma in both the penile ulcer and the lung lesion. After antisyphilitic treatment, the lung lesion shrunk remarkably and at the same time the skin eruption and the systemic symptoms also improved.
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ranking = 2
keywords = eruption
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10/17. pityriasis rosea eruption in secondary syphilis: an isomorphic phenomenon?

    A 41-year-old man was referred because of a slightly pruritic eruption, and a classic case of pityriasis rosea was diagnosed on the first examination. Results of routine tests for syphilis were strongly positive, and on repeated examination the eruption had grown further. skin biopsy specimens showed plasma cells and treponema pallidum. All symptoms disappeared following antisyphilitic treatment. The possibility of an isomorphic response is discussed.
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ranking = 6
keywords = eruption
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