Papulonodular secondary syphilis: a rare clinic presentation confirmed by serologic and histologic exams

Abstract

Syphilis is a sexually transmitted disease caused by Treponema pallidum and divided into three stages according to the duration of the disease: primary, secondary and tertiary. Secondary syphilis has diverse clinical presentations, such as papular-nodular lesions. This presentation is rare, with 15 cases reported in the literature over the past 20 years. We report a case of secondary syphilis with papular-nodular lesions in a healthy 63-year-old patient, who has presented treponema in immunohistochemical examination of the skin lesions.

Primary syphilis occurring as an extensive ulceration on the palatal gingival mucosa diagnosed by immunohistochemical staining

“…Another important feature that usually accompanies the primary stage syphilis, and most valuable for its diagnosis, is a visible unilateral lymphadenopathy, with the lymph nodes appearing enlarged, firm and painless. 1,3 This feature was absent in the present case.…”

“…As we know, longitudinal melanonychia refers to a longitudinal pigmented band that extends from the proximal nail fold to the distal nail plate and it can have melanocytic or non-melanocytic origin. 1 The differential diagnosis includes nail matrix melanoma,…”

“…Clinically, it has four stages: primary, secondary, latent and tertiary. 1,2 In most instances, the diagnosis is made during the secondary stage, on which lesions are more numerous, symptomatic, and may affect skin and mucosa areas simultaneously. On the other hand, the primary stage manifests by single, usually painless, ulceration that goes into spontaneously healing between 2-4 weeks after its appearance.…”

“…More often than not, the primary stage is usually missed as patients did not seek any medical evaluation. 1,3 This article reports a case of painful primary syphilis on the oral mucosa that was, otherwise, diagnosis by a combination of histopathology and immunohistochemical assay.…”

Corymbiform syphilis associated with three other sexually transmitted infections

“…The disease is divided into stages according to its duration: primary, secondary, latent, and tertiary syphilis. 1 The dermatological manifestations of the secondary stage are diverse, with reports of macular, papular, nodular, and lichenoid lesions, among others. The presentation of secondary syphilis with corymbiform lesions is extremely rare.…”