Leucodermia sifilítica: expressão rara do secundarismo diagnosticada por exame histopatológico

Abstract

Biopsies are occasionally necessary to confirm the diagnosis of secondary-stage syphilis, currently achieved by clinico-serological correlation. However, histopathologic examination may offer clues that can lead to the diagnosis of the disease in previously unsuspected or unusual cases. We report the case of a 35-year-old male patient with vitiligo-like lesions for two years, whose diagnosis of syphilis was suggested only after histopathologic examination. Some microscopic aspects observed are discussed and compared to data from the literature. Keywords: Dermatitis; Histology; Syphilis, cutaneous; Treponemal infections Resumo: Biópsias são ocasionalmente necessárias para confirmação diagnóstica de sífilis secundária, normalmente obtida por correlação clínico-sorológica. Entretanto, o exame histopatológico pode oferecer pistas que conduzam a um diagnóstico em casos antes insuspeitos ou de apresentação clínica incomum. Apresentamos um paciente de 35 anos, há dois com lesões acrômicas vitiligoides, para o qual sífilis foi sugerida somente após o exame histopatológico. Alguns aspectos microscópicos observados são discutidos e comparados com dados disponíveis na literatura.

Secondary syphilis presenting as leucoderma syphiliticum: case report and review

“…In sharp contrast, current reports of LS have never mentioned the cervical region. The dyschromic rash favors the upper extremities and hands 12 - 14 , 16 , genitals 14 - 17 , and trunk 13 , 16 , 18 .…”

“…Histopathologic studies may show absence of melanin in the epidermis 13 and even the presence of treponemes around vessels and inside nerve fibers 16 . Penicillin treatment may result in repigmentation of LS macules within a few weeks 12 , 13 , 15 or months 14 , 17 .…”