Ann Dermatol.  2009 Nov;21(4):399-401. 10.5021/ad.2009.21.4.399.

A Case of Syphilitic Keratoderma Concurrent with Syphilitic Uveitis

• Hwang SW
• Kang JH
• Chun JS
• Seo JK
• Kim HW
• Lee D
• Sung HS

• KMID: 2156505
• DOI: http://doi.org/10.5021/ad.2009.21.4.399

Abstract

Syphilitic keratoderma is a rare cutaneous manifestation of secondary syphilis, characterized by symmetrical and diffuse hyperkeratosis of the palms and soles. In addition, no cases of syphilitic keratoderma and uveitis have been reported in the dermatologic literature. A 69-year-old woman presented with steroid-resistant hyperkeratotic patches on the palms and soles and uveitis for 4 months. As steroid-resistant uveitis must be evaluated for syphilis, viral infections, and autoimmune diseases, we ran several laboratory tests and the serologic test for VDRL was reactive (titer; 1:128). After treatment with penicillin G (4 MU, IV every 4 hours for 2 weeks), her skin lesions and visual disturbance were completely resolved. Therefore she was diagnosed as having syphilitic keratoderma and uveitis. Here, we report a rare case of syphilitic keratoderma concurrent with syphilitic uveitis and suggest that evaluation for syphilis may be required when skin lesions and ocular disturbance are resistant to long-term steroid therapy.

Keyword

Keratoderma; Syphilis; Uveitis

MeSH Terms

Aged
Autoimmune Diseases
Female
Humans
Penicillin G
Serologic Tests
Skin
Syphilis
Uveitis
Penicillin G
Syphilis

Figure

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  Fig. 1 Volar aspects of both hands (A) and both feet (B) show diffuse scaling and thickening. Fundoscopic findings showed that the optic disc was obscured by a dense vitreous haze, which suggested uveitis (C).

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  Fig. 2 (A) Hyperkeratosis, parakeratosis, acanthosis and irregular rete elongation in the epidermis and lichenoid inflammatory cell infiltration in the upper dermis (H&E, ×40). (B) The dermal infiltrate consists of lymphohistiocytes and sparse plasma cells (H&E, ×400).

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  Fig. 3 After treatment with potassium penicillin G, the skin lesions resolved completely (A, B) and the optic disc was clearly seen in fundoscopic findings (C).

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