Secondary syphilis presenting as a corymbiform syphilide: case report and review

Abstract

It is essential that healthcare providers are familiar with the full spectrum of clinical presentations of syphilis. A rare manifestation of secondary syphilis is the corymbiform (or corymbose) arrangement, in which a central greater papule is surrounded by smaller satellite lesions. Very few reports of corymbiform syphilis are available in current biomedical databases. We present the case of a 28 year-old HIV-infected male patient on regular, successful antiretroviral therapy who developed an asymptomatic corymbiform maculopapular lesion in the medial aspect of the right thigh. There were also a few brownish macular lesions on the left sole. New serological tests for syphilis (which had been negative in the past) were reactive. The coymbiform lesion slowly regressed and the non-treponemal test reverted to negative after benzathine penicillin G treatment. A review of the literature is provided. This is the first report of corymbiform syphilis in an HIV-infected patient.

Secondary syphilis resembling erythema annulare centrifugum

“…Syphilis lesions are usually asymptomatic and may undergo spontaneous remission. In addition, these patients can be asymptomatic for various years before developing tertiary syphilis and therefore affecting severely other organs, leading in some cases to life-threatening complications 2…”

“…The most common cutaneous presentation for secondary syphilis is a generalised, non-pruritic, papulosquamous eruption varying from pink to brown; but it can present with different atypical features, especially in the immunocompromised patient: macular, maculopapular, papulosquamous,3 nodular,1 psoriasiform,4 pustular, impetigo-like,5 vesicular, corymbose,2 lenticular, annular,6 7 follicular, ulceronecrotic, granulomatous and pigmentary lesions 2 8. Mucous membrane lesions are infectious 8…”

Corymbiform cutaneous disorders in pediatric dermatology: Exploring this pattern of presentation beyond secondary syphilis

“…"Corymbiform" appears in available medical literature as early as 1876 in reference to one possible morphology of secondary syphilis as a "corymbiform syphilide." [1][2][3] Early reports describe this configuration as consisting of a central larger lesion with surrounding smaller lesions, which may be either separate from or confluent with the central larger lesion, leading to the appearance of an irregular border. 2,4 The current dermatology literature does not appear to frequently use the term corymbiform outside of perhaps secondary syphilis.…”

Corymbose Syphilis

“…A complete resolution of clinical manifestations and a 4-fold decrease in Venereal Disease Research Laboratory titer were observed after 3 months. Syphilis may rarely have a “corymbo” appearance, that is, reminiscent of a flat-topped flower cluster in which the individual flower stalks grow upward from various points of the main stem to the same height 1,2 …”

“…Syphilis may rarely have a "corymbo" appearance, that is, reminiscent of a flat-topped flower cluster in which the individual flower stalks grow upward from various points of the main stem to the same height. 1,2 ORCID IDS Paolo Gisondi https://orcid.org/0000-0002-1777-9001 Francesco Bellinato https://orcid.org/0000-0002-6163-6921…”