ATYPICAL DERMATOLOGICAL MANIFESTATIONS OF SYPHILIS IN ADVANCED HIV: A CASE-BASED NARRATIVE REVIEW
Main Article Content
Keywords
Dermatitis
Abstract
Syphilis is re-emerging globally, particularly among people living with HIV. Secondary syphilis classically presents with a maculopapular rash involving the trunk and extremities, but atypical cutaneous manifestations are increasingly recognized, especially in immunocompromised patients. We report the case of a 60-year-old male living with HIV with poor adherence who presented with intermittent fever, dry cough, and widespread, non-pruritic polymorphic skin lesions sparing the palms and soles. The patient had a prior history of treated latent syphilis. Physical examination revealed papule-nodular and annular lesions with minimal scaling. Initial diagnostic workup excluded common differentials including monkeypox and fungal infections. Serologic testing confirmed active syphilis with a reactive Rapid Plasma Reagin (RPR) titer of 1:32. Skin biopsy showed dense plasma cell-rich infiltrate, and immunohistochemistry was positive for T. pallidum. Despite negative cerebrospinal fluid findings, neurological symptoms prompted treatment with intravenous penicillin G. Antiretroviral therapy was resumed concurrently. The patient’s symptoms resolved with treatment.
Downloads
Abstract 66
PDF Downloads 18
HTML Downloads 8
References
2. CDC Newsroom Releases. U.S. Syphilis Cases in Newborns Continue to Increase: A 10-Times Increase Over a Decade. [(accessed on 29 april 2025)]. Available online: https://www.cdc.gov/media/releases/2023/s1107-newborn-syphilis.html
3. Tiecco G, Degli Antoni M, Storti S, et al. A 2021 Update on Syphilis: Taking Stock from Pathogenesis to Vaccines. Pathogens. 2021;10(11):1364. doi:10.3390/pathogens10111364
4. Balagula Y, Mattei PL, Wisco OJ, Erdag G, Chien AL. The great imitator revisited: the spectrum of atypical cutaneous manifestations of secondary syphilis. Int J Dermatol. 2014;53(12):1434-1441. doi:10.1111/ijd.12518
5. Ciccarese G, Facciorusso A, Mastrolonardo M, Herzum A, Parodi A, Drago F. Atypical Manifestations of Syphilis: A 10-Year Retrospective Study. J Clin Med. 2024;13(6):1603. doi:10.3390/jcm13061603
6. HIV.gov. Syphilis and people with HIV. [(accessed on 29 april 2025)]. Available online : https://www.hiv.gov/hiv-basics/staying-in-hiv-care/other-related-health-issues/syphilis
7. Ivars Lleó M, Clavo Escribano P, Menéndez Prieto B. Atypical Cutaneous Manifestations in Syphilis. Manifestaciones cutáneas atipícas en la sífilis. Actas Dermosifiliogr. 2016;107(4):275-283. doi:10.1016/j.ad.2015.11.002
8. Marchese V, Tiecco G, Storti S, et al. Syphilis Infections, Reinfections and Serological Response in a Large Italian Sexually Transmitted Disease Centre: A Monocentric Retrospective Study. J Clin Med. 2022;11(24):7499. doi:10.3390/jcm11247499
9. Villaverde MRD, Villena JPDS, Yap Silva C. A Peculiar Pattern: Nodular Secondary Syphilis with Granulomatous Dermatitis. Acta Med Philipp. 2024;58(17):60-63. doi:10.47895/amp.v58i17.9040
Article Sidebar
Article Details
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers. Authors will grant copyright of their articles to the Institute of Hematology, Catholic University, Rome . No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.