Korean J Dermatol.  2011 Jan;49(1):68-71.

Malignant Syphilis in an Acquired Immune Deficiency Syndrome Patient

• Lee JY
• Kim MS
• Lee SH
• Kim HS
• Ahn JY
• Park MY

Abstract

Malignant syphilis (also known as lues maligna) is a rare dermatologic manifestation of syphilis and this is more commonly seen in patients with human immunodeficiency virus (HIV) infection. A 40-year-old man presented with general malaise and widespread cutaneous noduloulcerative lesions covered with lamellar crusts for 15 days. He had been diagnosed with HIV infection 6 years earlier, but had not regularly taken antiretroviral drugs. The syphilis serology showed a VDRL (venereal disease research laboratory) titer of 1 : 256 and a positive TPPA (treponema pallidum particle agglutination test) at presentation. Histologic exam showed the dense perivascular inflammatory infiltrates composed of lymphocytes, histiocysts and neurophils with some plasma cells in the underlying upper and reticular dermis. Obliterated blood vessels with eosinophilic materials were observed as an unusual histologic feature of syphilis. Based on the clinical, histological and serological findings, a diagnosis of malignant syphilis accompanied by acquired immune deficiency syndrome (AIDS) was made. The patient was treated with intramuscular benzathine penicillin G at 2.4 million units per week for 3 weeks, and the skin lesions completely healed with post-inflammatory hyperpigmentation. It is necessary to take into account this entity among the possible diagnoses in HIV-infected patients with cutaneous noduloulcerative lesions.

Keyword

AIDS; Malignant syphilis; Noduloulcerative lesions

MeSH Terms

Acquired Immunodeficiency Syndrome
Adult
Agglutination
Blood Vessels
Dermis
Eosinophils
Ethylenediamines
HIV
HIV Infections
Humans
Hyperpigmentation
Lymphocytes
Penicillin G Benzathine
Plasma Cells
Skin
Syphilis
Ethylenediamines
Penicillin G Benzathine