Secondary syphilis mimicking mycosis fungoides

Levin, Donald L.; Greenberg, Mark; Hasegawa, Junji; Roenigk, Henry H.

doi:10.1016/s0190-9622(80)80229-5

Cited by 10 publications

(7 citation statements)

References 7 publications

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“… 6 Moreover, several other cases since Abell’s have made equally compelling histological arguments for a diagnosis of MF. 7 – 10 However, when reported, the T-cell receptor (TCR) gamma/beta gene rearrangement assay was negative, and in some of the cases the Warthin-Starry stain demonstrated spirochetes. 8 , 9 In our patient, MF was not a consideration based on the rapidity of the eruption and more aggressive pathology seen from the skin biopsies.…”

Section: Discussionmentioning

confidence: 99%

“…In 1980, Levin et al described a patient with compelling evidence for the diagnosis of MF, only to later be revealed as a strange case of secondary syphilis. 7 Since Levin’s report, there have been other documented cases of secondary syphilis mimicking MF. 8 – 10 Our patient highlights similar points, and, in addition, offers an etiology to the cause of rupioid syphilis in HIV underlining the importance of a detailed medical history and adequate laboratory tests in an HIV infected patient.…”

Section: Introductionmentioning

confidence: 99%

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A Case of Rupioid Syphilis Masquerading as Aggressive Cutaneous Lymphoma

Braue

Hagele

Yacoub

et al. 2015

Mediterr J Hematol Infect Dis

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Secondary syphilis has been known since the late 19th century as the great imitator; however, some experts now regard cutaneous lymphoma as the great imitator of skin disease. Either disease, at times an equally fastidious diagnosis, has reported to mimic each other even. It is thus vital to consider these possibilities when presented with a patient demonstrating peculiar skin lesions. No other manifestation of secondary syphilis may pose such quandary as a rare case of rupioid syphilis impersonating cutaneous lymphoma. We present such a case, of a 36-year-old HIV positive male, misdiagnosed with aggressive cutaneous lymphoma, actually exhibiting rupioid syphilis thought secondary to immune reconstitution inflammatory syndrome (IRIS).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Case of Rupioid Syphilis Masquerading as Aggressive Cutaneous Lymphoma

Braue

Hagele

Yacoub

et al. 2015

Mediterr J Hematol Infect Dis

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“…Hair loss can also occur (moth-eaten alopecia/alopecia syphilitica), typically affecting the scalp, but also the eyebrows or total body hair loss. Secondary syphilis has been termed the “great masquerader”, because its skin lesions show such diverse clinical and/or histologic morphologies, mimicking alopecia areata (130), bullous pemphigoid (131), cutaneous lymphoid hyperplasia (pseudolymphoma) (132–135), erythema multiforme (126, 136), granuloma annulare (43, 128, 137, 138), histiocytoma (34), leprosy (128, 139, 140), lichen planus (34, 126, 135, 141, 142), lupus erythematosus (43, 128, 143), mycosis fungoides (126, 144–146), pemphigus vulgaris (147), pityriasis lichenoides et varioliformis acuta (PLEVA) (34, 126, 135), pruritic (eczematous) dermatoses (126, 128, 148), psoriasis (34, 128, 149, 150), pustular psoriasis (34, 128), sarcoidosis (34, 135, 151–155), small vessel vasculitis (156), suppurative folliculitis (157), superficial thrombophlebitis (158), Sweet’s syndrome (128, 159), tinea imbricata and erythema annulare centrifugum (34, 160), and urticaria (104). Ulcerative nodular presentations are rare and can occur secondary to follicular pustules (157, 161), or an obliterative endarteritis, known as lues maligna (162, 163).…”

Section: The Pathology Of Human Syphilismentioning

confidence: 99%

The Immunopathobiology of Syphilis: The Manifestations and Course of Syphilis Are Determined by the Level of Delayed-Type Hypersensitivity

Carlson

Dabiri²,

Cribier³

et al. 2011

The American Journal of Dermatopathology

158

136

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Syphilis has plagued mankind for centuries and is currently resurgent in the Western hemisphere. While there has been a significant reduction of tertiary disease, and recognition of facilitative interactions with HIV infection, the natural history of syphilis has remained largely unchanged; thus, new strategies are required to more effectively combat this pathogen. The immunopathologic features of experimental syphilis in the rabbit; the course, stages, and pathology of human syphilis; and a comparison of human syphilis with leprosy suggest that the clinical course of syphilis and its tissue manifestations are determined by the balance between delayed type hypersensitivity (DTH) and humoral immunity to the causative agent, Treponema pallidum. A strong DTH response is associated with clearance of the infecting organisms in a well-developed chancre, whereas a cytotoxic T-cell response or strong humoral antibody response is associated with prolonged infection and progression to tertiary disease. Many of the protean symptoms/appearances of secondary and tertiary human syphilis are manifestations of immune reactions that fail to clear the organism, due to a lack of recruitment and more importantly, activation of macrophages by sensitized CD4 T-cells. The Bacillus Calmette Guerin (BCG) vaccination can enhance DTH and has been shown to produce a low, but measurable beneficial effect in the prevention of leprosy, a disease that shows a disease spectrum with characteristics in common with syphilis. In the prevention of syphilis, a potential vaccine protective against syphilis should be designed to augment the DTH response.

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“…An unusual presentation in conjunction with failure to recognize the causes of rare false‐negative testing for secondary syphilis led to a delayed diagnosis in this patient. Although syphilis and mycosis fungoides have previously been reported to mimic one another both clinically and histopathologically, the potential for secondary syphilis to be misdiagnosed in this fashion is not generally appreciated 13–15. Recognition of the possibility of secondary syphilis occurred just in time to spare this patient the “rash decision” of treating him with cytotoxic therapy directed against CTCL.…”

Section: Commentarymentioning

confidence: 96%