Vesicular syphilid in a seropositive patient

Abstract

Syphilis is a sexually transmitted infection with various stages of evolution and a myriad of presentations. To avoid a delay in diagnosis, it is important to recognize secondary syphilis presenting with vesicular lesions. A patient presented with maculopapular rash of recent onset with several vesicles and related the eruption to paracetamol taken one day before. The differential diagnoses considered were drug eruption, pityriasis lichenoides et varioliformis acuta, pityriasis rosea and secondary syphilis. HIV, VDRL (1:256) and TPHA tests were positive and histopathology revealed lymphohistiocytic infiltrate and plasma cells. Thus, a diagnosis of secondary syphilis coexisting with HIV was confirmed. The patient was administered benzathine penicillin and anti-retroviral therapy was started. He responded very well to treatment. We report this case because of the rarity of vesicular eruption in secondary syphilis.

A 30-Year-Old Man with HIV, Fever, and a Rash

“…Their morphologies range from papulosquamous, lentricular, pustular to annular [ 1 ]. There have been rare reports of secondary syphilis that has presented with vesicular lesions [ 2 ]. If secondary syphilis goes untreated, it will progress to tertiary syphilis, which presents with cardiovascular and neurologic symptoms [ 1 ].…”

Lesões vesiculares e prurido intenso em paciente com sífilis secundária:manifestação clínica atípica

“…As formas clínicas variavam desde lesões vesiculares nas plantas [2,5], erupção bolhosa penfigóide like [3]e rash maculopapular com vesículas [6] . Dos 7 casos encontrados, 2 pacientes eram HIV positivos [5,6] e 2 apresentaram reação de Jarisch-Herxheimer com lesões bolhosas [7,8] . Fora os casos relacionados à reação, os pacientes com secundarismo obtiveram melhora das lesões e queda dos títulos do VDRL com o uso de Penicilina Benzatina.…”