Malignant syphilis in an immunocompetent female patient

Abstract

Malignant syphilis is an uncommon manifestation of secondary syphilis, in which necrotic lesions may be associated with systemic signs and symptoms. Generally it occurs in an immunosuppressed patient, mainly HIV-infected, but might be observed on those who have normal immune response. Since there is an exponential increase in the number of syphilis cases, more diagnoses of malignant syphilis must be expected. We report a case in an immunocompetent female patient.

Early malignant syphilis

“…Early malignant syphilis (EMS) was described by Bazin in 1859 and Dubuc in 1864 as a nodular variant of secondary syphilis with aggressive development. 6 , 8 - 10 Its diagnosis was common in the seventeenth century, but its incidence has subsequently declined. 4 Years before the discovery of penicillin, in times of war and famine, EMS was observed in cachectic patients with tuberculosis.…”

“…Although the current treatment for secondary syphilis consists of two penicillin G benzathine injections at a dose of 2,400,000 IU at weekly intervals, in our case we chose the total dose of 7,200,000 IU, as some authors recommend increasing the dose in case of HIV coinfection or in cases of immunosuppression. 1 - 4 , 6 , 8 , 10 For resistant cases or relapses, prolonged therapy with high doses of penicillin is suggested. 6…”

Secondary Syphilis in Man: Prozone Effect

“…Congenital Syphilis may be recent or late, with mean, can have less or more than two years of evolution, respectively. Infection acquired when untreated, up to 35% will evolve to cure, 35% to latent form, and the remainder will progress to the tertiary stage [4] [5] [6]. Congenital syphilis is responsible for high rates of neonatal death, fetal death and miscarriage.…”

Cutaneous leukocytoclastic vasculitis as the first manifestation of malignant syphilis coinfected with human immunodeficiency virus

“…The exact mechanism of malignant syphilis is not yet known. Before the outbreak of HIV infection, the frequency was 0.12% to 0.36% and now about 7% . It seems that the pathogenic interaction between HIV and T. pallidum may reduce the immunologic response to treponemal infection .…”

“…Before the outbreak of HIV infection, the frequency was 0.12% to 0.36% 3 and now about 7%. 4 It seems that the pathogenic interaction between HIV and T. pallidum may reduce the immunologic response to treponemal infection. 5 However, it has also been described in immunocompetent patients.…”