Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma

Abstract

Malignant syphilis or lues maligna is a severe form of secondary syphilis that was commonly reported in the pre-antibiotic era, and has now reemerged with the advent of the human immunodeficiency virus (HIV) epidemic. However, the characteristic histopathological findings of malignant syphilis remain controversial. The aim of this case report was to clarify the clinical and histopathological findings of HIV-positive malignant secondary syphilis. A Japanese man in his forties complained of fever, skin lesions, headache, and myalgia without lymphadenopathy during the previous 4 weeks. The skin lesions manifested as erythematous, nonhealing, ulcerated papules scattered on his trunk, extremities, palm, and face. Although the skin lesions were suspected to be cutaneous T-cell lymphomas on histological analyses, they lacked T-cell receptor Jγ rearrangement; moreover, immunohistochemical analyses confirmed the presence of spirochetes. The patient was administered antibiotics and anti-retroviral therapy, which dramatically improved the symptoms. On the basis of these observations of the skin lesions, we finally diagnosed the patient with HIV-associated secondary syphilis that mimicked cutaneous T-cell lymphoma. The patient’s systemic CD4+ lymphocyte count was very low, and the infiltrate was almost exclusively composed of CD8+ atypical lymphocytes; therefore, the condition was easily misdiagnosed as cutaneous lymphoma. Although the abundance of plasma cells is a good indicator of malignant syphilis on skin histological analyses, in some cases, the plasma cell count may be very low. Therefore, a diagnosis of malignant secondary syphilis should be considered before making a diagnosis of primary cutaneous peripheral T-cell lymphoma or lymphoma associated with HIV infection.

CD8‐positive pseudolymphoma in lues maligna and human immunodeficiency virus with monoclonal T‐cell receptor‐beta rearrangement

“…In patients with HIV and syphilis, the clinical and histological appearance of PSL is different. Our case and those reported in the literature presented with non‐healing papules, some with central ulceration, lesions at palms and soles, general lymphadenopathy and other general symptoms, for example, weight loss or myalgia. These are classical signs of syphilis maligna.…”

“…The face, palms and soles are also affected. Skin eruptions in HIV and syphilis can mimic cutaneous lymphoma, thus meeting the criteria of cutaneous pseudolymphoma (PSL) …”

Syphilis Maligna (Lues Maligna): A Case Report

“…The abundance of plasma cells is a good indicator of malignant syphilis on skin histological analyses, in some cases, the plasma cell count may be very low and cutaneous T-cell lymphoma could be misdiagnosed. 14 No differences in a comparative immunohistologic study were observed between HIV patients and patients who were HIV negative. 12 Diagnosis of malignant lues should be considered in all HIV-infected individuals who have nodules.…”

“…1 Most of the cases, resulting from human immunodeficiency virus (HIV)-induced suppression of cell mediated immunity, have been reported in HIV positive patients [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] but some cases occur in individuals with poor health, alcoholic or immunocompetent patients.…”

Peripheral T-cell lymphoma mimicking classic Hodgkin’s lymphoma in a patient presenting with fevers of unknown origin

“…Aetiologies in the literature reported to mimic PTCL include Hodgkin’s disease,10 cirrhosis and other hepatic diseases,11–13 cellulitis,14 stroke,15 ulcer,16 post-transplant lymphoproliferative disease (PTLD)17 and FUO18 (table 1). In addition, there are reports of PTCL having been diagnosed after initially mimicking alternate diagnoses, including Mycobacterium,19 EBV,20–22 natural killer lymphoma,23 tuberculosis24 and syphilis25 (table 2). With Hodgkin’s lymphoma in particular, Gaulard et al first noted the utility of combining histology and immunohistochemistry to reveal a clonal T-cell population to distinguish the aforementioned entities 26.…”