Skin rash, dyspnea and bone pain: secondary syphilis

Abstract

CaseA 50-year-old healthy male was seen for a 6-week history of right leg pain, occasional dyspnea and extensive non-pruritic skin rash in trunk and extremities (Fig. 1A). Physical examination revealed tachypnea with normal breath sounds and a non-confluent maculo-papular rash in the trunk and extremities. No adenopathies, mucosal or palmo-plantar lesions were evident.A contrast-enhanced CT scan showed presence of multiple axillary, hilar, and mediastinal lymphadenopathy (Fig. 1B), and bilateral and diffusely distributed pulmonary nodules with ground-glass density (Fig. 1C). Bone scintigraphy showed increased uptake of isotope on the right tibia (Fig. 1D). The Rapid Plasma Reagin test (RPR) was positive in 128 dilutions, with a positive Treponema pallidum microhemagglutination assay. Human immunodeficiency virus and serology of other * (J. Manríquez). sexually transmitted diseases were negative. Additional laboratory investigation revealed negative antinuclear antibodies, as well as negative anti-double-stranded DNA, anti-Smith, anti-Ro, anti-La, and anti-neutrophil cytoplasmic antibodies. Complement C3 and C4 levels were within normal ranges. Skin biopsy revealed epidermal orthokeratosis and dermis with perivascular and periadnexal infiltrate composed by lymphocytes, neutrophils and plasma cells. Immunohistochemistry was positive for T. pallidum using monoclonal antibodies.Considering the above mentioned data a diagnosis of secondary syphilis affecting skin, bone (periostitis), and pulmonary was established. The patient was successfully treated with three-weekly doses of 2.4 million units of intramuscular benzathine-penicillin. Secondary syphilis is characterized by multisystem involvement: skin rash, mucosal lesions, and generalized lymphadenopathy. Simultaneous skin, lung, and skeletal involvement are extremely infrequent, with no cases reported until now.http://dx.

A Study on Clinical, Serological Characteristics of Secondary Syphilis Patients at Can Tho Hospital of Dermato-Venerology in 2021

“…According to Nguyen Thi Thanh Tho (2017), lesions in the palms or soles accounted for 21.7%, especially lesions in many locations accounted for 32.1% [12]. Author Manriquez et al (2014) reported that the sites of skin lesions on the palms or soles accounted for 35%, this rate is lower than our study, possibly due to the difference in the sample size [7].…”

Unusual presentations and pitfalls of secondary syphilis: osteitis, pneumonia and malignancy

“…We could find eight more English language case reports from 2009 to 2014 5–12. One of them presented with both bone and lung lesions, as did our second patient 12. Concomitant HIV infection was present in four patients, absent in seven and unknown in six.…”

Pulmonary involvement of secondary syphilis

“…A literature review by David et al 2 in 2006 reported only nine cases of pulmonary syphilis in 37 years ; however, 12 cases were reported in the subsequent eight years. [2][3][4][5][6][7][8][9][10][11][12][13][14] Although a worldwide increase in syphilis incidence was reported in the 2000s, it is still lower than the incidence observed from the 1970s to the 1990s; therefore, the increasing number of cases of pulmonary syphilis is likely not due to the relatively higher syphilis incidence reported recently.…”

“…Interestingly, multiple subpleural nodules were found in all of chest CT scans. [2][3][4][5][6][7][8][9][10][11][12][13][14] reported that no specific lesion could be identified in their literature review. However, recent case reports reveal that multiple subpleural nodules (typically located in the lower lobes) are considered one of the prominent features of pulmonary syphilis.…”