Extensive Nodular Secondary Syphilis With Prozone Phenomenon

The great imitator revisited: the spectrum of atypical cutaneous manifestations of secondary syphilis

“…Nodular syphilis may present with localized or generalized erythematous and violaceous nodules and plaques (Fig. ) . The palms, soles, and mucosal surfaces are often spared .…”

“…), which may falsely suggest other etiologies such as scleromyxedema, lipoid proteinosis, lepromatous leprosy, lymphoma, leukemia cutis, and certain forms of histiocytosis . Importantly, the prozone phenomenon (a false negative rapid plasma reagin [RPR] or Venereal Disease Research Laboratory [VDRL] test result caused by very high antibody titers) should be considered when initial serologic workup is negative but syphilis is clinically suspected …”

“…Histologic findings are variable and may demonstrate acanthosis, perivascular and periadnexal infiltrate with lymphocytes, plasma cells, histiocytes, and eosinophils . Lichenoid infiltration with basal cell layer vacuolization and a characteristic slender elongation of rete ridges, or a dense nodular infiltrate composed primarily of lymphocytes with histiocytes and plasma cells, may also be seen.…”

Issues of serological diagnosis of syphilis. Interpretation of the results of serological tests

“…Известен так называемый феномен, или эффект прозоны, когда у больного с «цветущим» сифилисом (вторичный, РСС) наблюдается отрицательный ре-зультат серологических реакций на сифилис (в част-ности, НТТ) ввиду конкуренции антител с разной валентностью за сайты связывания с антигеном; при этом может наблюдаться блокада антигенных детер-минант и парадоксально отрицательный результат реакции [30][31][32][33][34][35]. Выходом из данной ситуации яв-ляется разведение сыворотки крови и ее повторное тестирование в разведениях (титры).…”

Cutaneous Hematopathology

“…The reddishpurple nodules and plaques, with/without peripheral scaling, are characteristically bilateral, symmetric, more prominent on the upper extremities and, albeit in the early stages, on the palms and soles (Sanches 2003 ). A case with the clinical presentation of infi ltrated, erythematous to violaceous, coalescent plaques on the trunk, limbs, and face, giving an almost leonine facies simulating T-or B-cell lymphoproliferative disease, has been reported (Battistella et al 2008 ).…”