Lues Maligna in a Chronic Alcoholic Patient

Abstract

Lues maligna, which is characterized by noduloulcerative lesions, is a rare form of secondary syphilis. It is mainly seen in either HIV-infected or malnourished patients suffering from a depression in immunity. We presented a chronic alcoholic, HIV negative male patient with noduloulcerative lesions diagnosed as lues maligna based on his skin eruptions, results of serologic tests, and, histopathologic findings. We believe that chronic alcoholism could be the cause of immunosuppression in our case and wanted to emphasize the possibility of an association between lues maligna and chronic alcoholism.

Lues Maligna

“…These findings were consistent with lues maligna or malignant syphilis, a severe, ulceronodular form of secondary syphilis that has been reported in conjunction with untreated HIV-1 infection and other immunodeficiencies [1–4]. Histologic examination of this patient’s lesions demonstrated the characteristic abundance of plasma cells and endothelial hyperplasia seen in lues maligna (Figure 2) [2, 3, 5].…”

Diffuse Eruption of Necrotic Papules and Nodules

“…However, it is important to note that lues maligna can spare palmar and plantar skin. 4,7 The common histopathologic pattern for syphilis is superficial and deep lymphocytic inflammation with plasma cells. 9 However, as corroborated by the present case, syphilis may exhibit a predominantly granulomatous pattern.…”

“…2 Prior to the advent of the HIV epidemic, the incidence of lues maligna was exceptionally uncommon, with only 14 reports from 1900 to 1988 in the English literature. 3 Although recent attention has focused on lues maligna in HIV-infected patients, several cases have been reported in HIV-negative patients, [4][5][6][7] most of whom had comorbid health problems of alcoholism or malnutrition.…”

Lues Maligna as an Initial Presentation of Underlying HIV Infection in a Homosexual Man

“…Lues maligna was described well before the HIV pandemic and it was associated with severe malnutrition, alcoholism, diabetes mellitus and intravenous drug use (19)(20)(21). Following the HIV/AIDS epidemic, the incidence of lues maligna significantly increased; moreover, the patients with HIV were 60 times more likely to present with this form of syphilis (22).…”