Vasculite leucocitoclástica: mais uma "imitação" da sífilis

Abstract

Syphilis, a disease that in the past was associated with significant morbidity and lethality rates, has resurged in recent years principally as a consequence of changes in risk behavior. An epidemiological group that is commonly affected is the HIV-infected population. The characteristics of the disease and its progression may differ in these patients. The present report describes a case of an HIV-positive male patient, who developed florid secondary syphilis: in addition to syphilitic roseola, he also presented with bilateral panuveitis and involvement of the central nervous system. Investigation revealed the prozone phenomenon and histological examination of the skin lesions showed the presence of leukocytoclastic vasculitis. This finding is extremely rare and few cases have been documented. Keywords: Histology; Syphilis; Syphilis serodiagnosis; HIV; Vasculitis Resumo: A sífilis, doença de importante morbiletalidade no passado, tem ressurgido nos últimos anos, graças, sobretudo, às alterações nos comportamentos de risco. Um grupo epidemiológico, frequentemente, acometido é a população com infecção pelo HIV: estes pacientes podem apresentar características peculiares nas manifestações e evolução da doença. Relatamos o caso de um paciente masculino, HIV-positivo, que desenvolveu um quadro florido de secundarismo: além da roséola sifilítica, apresentou pan-uveíte bilateral e acometimento do sistema nervoso central. A investigação, apresentou fenomeno pro-zona e no estudo histologico, mostrou a presenca de vasculite leucocitoclastica achado este extremamente raro e pouco documentado.

Periungual Lesion due to Secondary Syphilis

“…The discovery and introduction of penicillin as a form of treatment caused a dramatic reduction of its incidence as well as of morbidity and mortality [1,2]. Despite this great advancement, in the last few years, an increase in the incidence rate of the disease has been observed in several countries, associated with a change in risk behaviors, particularly in the group of men who have sex with men [3,4,5]. In the United States, the annual detection rate of primary and secondary syphilis increased from 2.1 to 5.3 cases per 100,000 inhabitants during 2000 to 2013 [6].…”

Secondary syphilis presenting as leukocytoclastic vasculitis in a 61-year-old man

“…However, LCV association with syphilis is extremely rare, with five cases reported in the literature (Table 1). One case was associated with congenital syphilis [11], another with primary syphilis [14], and three with secondary syphilis [12,13,15]. All patients were males ranging from 45 days to 74 years old.…”

“…All patients were males ranging from 45 days to 74 years old. Three cases showed the typical palpable purpuric eruption of LCV and two cases were associated with HIV infection [11][12][13][14][15].…”

“…The dermal vessels often show endothelial cell swelling with or without fibrinoid necrosis of the vessel wall [9,10]. Cases of syphilis manifesting with LCV are rare, with only a few cases reported in the literature, including congenital, primary, and secondary syphilis in HIV patients [11][12][13][14][15]. We report an interesting case of secondary syphilis in a non-HIV patient presenting with clinical and histopathological features of LCV.…”