A case of secondary syphilis misdiagnosed as psoriasis vulgaris: Discover the real cause beyond the surface with reflection confocal microscopy and leave the great imitator nowhere to hide

Zhang, Jianfeng; Li, Xia; Shi, Dongmei

doi:10.1111/srt.13374

Cited by 1 publication

(1 citation statement)

References 8 publications

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“…Cases of atypical primary syphilis misdiagnosed as pharyngeal lymphoma, tongue cancer, and other types of oral squamous cell carcinomas have been described [39][40][41]; however, the secondary stage of the disease, given the possible involvement of the whole skin area and of other organs, is the one that is most prone to misdiagnosis like palmoplantar psoriasis, psoriasis vulgaris, erythema multiforme, cutaneous lymphoma, and granulomatous diseases of the skin (annular granuloma, sarcoidosis). Moreover, involvement of internal organs with signs and symptoms of osteomyelitis, nephrotic syndrome, retinitis, and others has been reported in secondary syphilis with or without typical cutaneous/mucosal involvement, further complicating the clinical picture [42][43][44][45][46][47]. In regards to neurosyphilis, a recent narrative review revealed a low level of clinical awareness of T. pallidum infection as a possible etiology of various psychiatric disorders including dementia, delirium, depression, mania, personality changes, and psychosis.…”

Section: Discussionmentioning

confidence: 99%

Atypical Manifestations of Syphilis: A 10-Year Retrospective Study

Ciccarese,

Facciorusso,

Mastrolonardo

et al. 2024

JCM

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Background: The incidence of syphilis has increased in high-income countries in the past few decades, especially among men who have sex with men. In the present study, we aimed to analyze the correlations between atypical syphilis manifestations and the demographic, clinical, and laboratory features of patients and to review unusual presentations of syphilis reported in the literature. Methods: We conducted a retrospective analysis of 307 patients with syphilis diagnosed between 1 January 2013 and 31 October 2023 at the sexually transmitted infection (STI) centers of the University of Genoa and University of Foggia with both typical and atypical manifestations of disease. Results: In our series, atypical manifestations were detected in 25.8% of the patients, especially in the secondary stage of the disease. Lesions with annular morphology and lesions presenting as itchy erythematous scaly plaques with a psoriasiform appearance were the most common atypical presentations of secondary syphilis. A statistical analysis revealed that homosexual orientation, syphilis reinfection, and venereal disease research laboratory (VDRL) titers > 1:32 were correlated with atypical manifestations. Conclusions: Our study demonstrates that the spectrum of syphilis manifestations, in all the stages of the disease, is wide; atypical manifestations often pose diagnostic challenges, may delay the provision of appropriate treatment, and facilitate the spread of the infection.

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