Eosinophil‐rich syphilis: a report of four cases

Abstract

The differential diagnosis for eosinophil-rich skin lesions often includes a drug reaction, allergic contact dermatitis and rarely, response to a helminth infection. However, many unrelated entities, such as infections, neoplasms and inflammatory dermatoses, can have a prominent eosinophilic infiltrate. Syphilis is classically associated with plasma cells, but other patterns of inflammation have been reported, including ulcerative, granulomatous and eosinophil-rich. Classic teaching might indicate that the presence of eosinophils argues against a diagnosis of syphilis. We present four cases of secondary syphilis with increased eosinophils, ranging from 8 to >200 eosinophils per 10 high-power fields (×400 magnification). Patient 1 had lesions on the penis and scrotum, with greater than 200 eosinophils per 10 high-power fields. Patient 2 had lesions on the back, with 150 eosinophils per 10 high-power fields. Patient 3 had lesions on the bilateral arms, with 8 eosinophils per 10 high-power fields. Patient 4 had lesions involving the anus, with 17 eosinophils per 10 high-power fields. These cases highlight that the presence of an eosinophil-rich infiltrate on skin biopsy should not exclude syphilis from the differential diagnosis.

Pruritic nodular secondary syphilis in a 61-year-old man with HIV infection

“…Although the classical histological findings of syphilis include predominantly plasma cell infiltration, other findings including ulcerative, granulomatous and eosinophil-rich patterns have to be considered for the diagnosis of secondary syphilis. 8,15 Among the differential diagnoses in an HIV-infected patient, we considered pruritic popular eruption of HIV, prurigo nodularis, drug-induced eruption, arthropod bite reaction, nodular scabies, cutaneous lymphoproliferative disorders, and spread of cutaneous infection, in addition to secondary syphilis.…”

“…Although the classical histological findings of syphilis include predominantly plasma cell infiltration, other findings including ulcerative, granulomatous and eosinophil-rich patterns have to be considered for the diagnosis of secondary syphilis. 8,15…”

Koinfeksi Sifilis Sekunder, <i>Condyloma Acuminata</i> dan <i>Human Immundeficiency Virus</i> (HIV) pada Pria Homoseksual

“…Gambaran histopatologi pada sifilis sekunder dengan HIV dapat ditemukan eosinofil pada lapisan dermis. 24 Pada kasus ini didapatkan hasil pemeriksaan histopatologi yang diwarnai dengan HE, dengan sediaan jaringan yang diambil dari daerah telapak kaki didapatkan gambaran reaksi jaringan tipe psoriasiformis pada epidermis dengan infiltrat sel radang dengan kepadatan sedang yang terdiri dari limfosit dan didapatkannya gambaran endarteritis obliteran yang merupakan gambaran proliferasi lapisan intima arteri dan vena. Pemeriksaan ini dapat membedakan dengan psoriasis yang pada pemeriksaan histopatologi akan didapatkan adanya mikroabses Munro, mikroabses Kogoj, serta tidak didapatkan adanya papilomatosis.…”

“…23 Pada sediaan ditemukan pula adanya eosinofil pada lapisan dermis yang sesuai dengan beberapa literatur yang menjelaskan mengenai eosinofil pada penderita koinfeksi sifilis sekunder pada HIV. 24 Spirochaeta akan lebih mudah terlihat bewarna coklat kehitaman pada pengecatan imunohistokimia terutama di epidermis, celah dermalepidermal, serta di dalam atau di sekitar pembuluh darah. 5 Pada sifilis sekunder dapat dilakukan pengecatan imunohistokimia menggunakan silver Levaditi, pewarnaan Warthin-Starry, teknik imunofluoresens.…”

A Case Report of Secondary Syphilis with Eosinophilic Spongiosis in an Human Immunodeficiency Virus Patient

“…Due to the heterogeneity of etiology, it is not specific for any diseases. Although previous studies have not discussed syphilis in the differential diagnosis of ES as tissue eosinophilia in syphilis is an uncommon finding, Park and Kim 4 reported a case of secondary syphilis with numerous eosinophils and Rosa et al 5 reported four cases of eosinophil-rich syphilis, with HIV co-infection identified in two of the cases.…”