Oral doxycycline in HIV-related synchronous malignant syphilis and condyloma lata

Avallone, Gianluca; Cavallo, Francesco; Susca, Sara; Mastorino, Luca; Trunfio, Mattia; Bonora, Stefano; Rugge, Walter; Calleri, Guido; Conti, Luca; Senetta, Rebecca; Marra, Elena; Fierro, Maria Teresa; Quaglino, Pietro; Ribero, Simone

doi:10.23736/s2784-8671.22.07232-2

Cited by 2 publications

(2 citation statements)

References 5 publications

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“…Our patient was treated with two doses of weekly IM BP and doxycycline to treat concurrent staphylococcal skin and soft tissue infection and rectal chlamydia. Oral tetracyclines have also been used with good clinical response in the treatment of UNRS [ 6 , 7 , 10 , 19 , 32 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

An Exuberant Case of Ulceronodular-Rupioid (Malignant) Syphilis in an HIV Patient: A Proposal for New Diagnostic Criteria

Jimenez,

Rabe,

Agarwal

et al. 2024

Infectious Disease Reports

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We report the case of a 28-year-old male with uncontrolled human immunodeficiency virus (HIV) infection who presented with extensive ulcerated lesions with dark lamellated crusting on his face, torso, and limbs. The patient had a rapid plasma reagin (RPR) titer of 1:512, indicative of syphilis. A skin biopsy revealed granulomata surrounded by lymphocytes, histiocytes, and plasma cells, with spirochetes visible on immunohistochemical staining. The patient’s rash resolved with hyperpigmented scarring after penicillin and doxycycline treatment. This severe form of secondary syphilis has been termed malignant syphilis, lues maligna, ulceronodular syphilis, or rupioid syphilis. We propose a single descriptive name for this entity, ulceronodular-rupioid syphilis. In 1969, Fisher proposed criteria for malignant syphilis based on lesion appearance, histopathologic findings, high RPR values, and rapid response to treatment. We found that the Fisher criteria were imprecise with respect to specific histopathologic findings, the quantitation of RPR values, and what constitutes rapid response to treatment. Thus, we examined an additional 74 cases from the literature and propose new diagnostic criteria based on rash appearance, histopathologic characteristics, non-treponemal and treponemal test positivity, and response to therapy. We also found that uncontrolled viremia, and not a low CD4 count, is a major risk factor for ulceronodular-rupioid syphilis in HIV patients.

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Section: Discussionmentioning

confidence: 99%

An Exuberant Case of Ulceronodular-Rupioid (Malignant) Syphilis in an HIV Patient: A Proposal for New Diagnostic Criteria

Jimenez,

Rabe,

Agarwal

et al. 2024

Infectious Disease Reports

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“…Treponema pallidum is a bacterium that belongs to the Spirochetes phylum, Spirochaetales classification and order [ 1 , 2 ]. Syphilis can present in many different ways based on the stage of the disease (primary, secondary, latent, and tertiary).…”

Section: Introductionmentioning

confidence: 99%

A Peculiar Presentation of Syphilis as a Mysterious Rash: A Dermatological Dilemma

Lopez,

Kwentoh,

Valdez Imbert

2023

Cureus

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A renowned poet in the ancient city of Verona by the name of Girolamo Fracastoro coined the term syphilis in 1530. The stigma and shame that embodied this affliction has been time immemorial and disabling for patients. The hypothesis of the spread from the warm tropics of west and central Africa to the Iberian Peninsula accompanied by the slave trade has been a tale for centuries. Malignant syphilis is a rare skin manifestation of Treponema pallidum infection and a variant of secondary syphilis. The rash is frequently associated with HIV-infected patients, often with low cluster differentiation 4 (CD4) cell count. The authors reported a unique case involving a 46-year-old woman who presented with a one-week history of skin eruptions at various stages. Subsequent laboratory tests revealed a strong positive result for Treponema pallidum and a positive Rapid Plasma Reagin (RPR) test with a titer of 1:16. She received doxycycline because she had a history of penicillin anaphylaxis in the past. She did well, with a remarkable improvement in symptoms - a positive outcome for this catastrophic stigmatizing, rare diagnosis.

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Oral doxycycline in HIV-related synchronous malignant syphilis and condyloma lata

Cited by 2 publications

References 5 publications

An Exuberant Case of Ulceronodular-Rupioid (Malignant) Syphilis in an HIV Patient: A Proposal for New Diagnostic Criteria

An Exuberant Case of Ulceronodular-Rupioid (Malignant) Syphilis in an HIV Patient: A Proposal for New Diagnostic Criteria

A Peculiar Presentation of Syphilis as a Mysterious Rash: A Dermatological Dilemma

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