Corymbiform syphilis associated with three other sexually transmitted infections

Abstract

Secondary syphilis can have different clinical presentations, with corymbiform rash as its rarest manifestation. The disease is characterized by a central papule surrounded by smaller ones. We report the case of a man who has sex with man with corymbiform syphilis. The patient was subsequently diagnosed with HIV infection, hepatitis B, non-gonococcal urethritis, as well as infection of the central nervous system by treponema. This case not only illustrates a rare presentation of secondary syphilis, but also demonstrates the importance of further investigation of sexually transmitted infections, particularly among at-risk patients.

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

“…Non-treponemal tests, however, only reverted after three consecutive weekly administrations of 2.4 million units of intramuscular benzathine penicillin G were administered. The few available reports of corymbiform syphilis showed full clinical recovery after appropriate treatment 2 , 10 , 13 . Our patient presented with few dermatologic lesions.…”

“…Atypical cutaneous manifestations of the secondary syphilitic rash may be more common than generally assumed and include (but are not limited to) annular, nodular, pustular, psoriasiform, circinate, bullous, rupioid, framboesiform, nodular-ulcerative, ulceronecrotic, granulomatous, vesicular, follicular, pigmentary (leukoderma syphiliticum and pigmentary syphilide ), and corymbose lesions 7 , 8 . Very few case reports of syphilitic lesions of the corymbose type are available in current biomedical databases 2 , 9 - 13 .…”

“…This classic text offers some historic images of corymbiform syphilides that share close resemblance to our patient’s rash ( Figure 2 ). Some authors have also suggested that corymbose syphilis may be a sign of reinfection 10 , 13 . Finally, Baughn and Musher 7 stated that no other dermatologic disease causes this type of lesion.…”

“…Our patient presented with few dermatologic lesions. Corymbose syphilis may present as single 2 , 10 or several 12 , 13 corymbiform arrangements. Fournier 14 suggested that fewer lesions are an indication of late presentations of secondary syphilis.…”