A case of tertiary syphilis manifested with multiple skin gummas

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Abstract

The tertiary cutaneous syphilis has become extremely rare as a result of the effective treatment of early syphilis with penicillin and occasional antibiotic therapy for concomitant infections. We report a case of tertiary gummatous syphilis associated with asymptomatic neurosyphilis that was initially misdiagnosed as basal cell carcinoma of the skin. A 67-year-old woman presented with the 18-month history of multiple, firm, bluish-red asymptomatic nodes on the parietal scalp, chin and lateral part of the trunk that had developed without preceding trauma. One node on the trunk had small central ulceration covered with dry yellowish crust. On the left retroauricular area the brownish-purple atrophic scar was observed. Blood tests revealed reactive VDRL, ELISA and TPHA assays. Skin biopsy has showed endarteritis with endothelial swelling and caseating granulomas along with plasmocytic infiltrate in the dermis and subcutaneous tissue. Increased lymphocyte count and the positive VDRL test with cerebrospinal fluid have confirmed the diagnosis of asymptomatic syphilitic meningitis in this patient. The treatment with aqueous penicillin intravenously has lead to resolution of the skin infiltrates and progressive more than 4-fold reduction of follow-up serum VDRL titers. This case is reported as a reminder of the possibility of tertiary syphilis with misleading clinical patterns in patients infected during the epidemics of 1995-2000. We would like to emphasize the necessity to perform timely serological and pathomorphological study to prevent misdiagnosis and mistreatment.

About the authors

T. V. Krasnoselskikh

First Pavlov State Medical University

Author for correspondence.
Email: tatiana.krasnoselskikh@gmail.com
Россия

G. N. Mikheev

First Pavlov State Medical University

Email: noemail@neicon.ru
Россия

A. E. Grigorian

First Pavlov State Medical University

Email: noemail@neicon.ru
Россия

V. V. Yastrebov

First Pavlov State Medical University

Email: noemail@neicon.ru
Россия

E. V. Sokolovskiy

First Pavlov State Medical University

Email: noemail@neicon.ru
Россия

References

  1. Доля О.В., Гребенюк В.Н. Бугорковый сифилид - клиническое проявление третичного сифилиса. Клин. дерматол. венерол. 2011; (2): 45-47
  2. Суворов А.П., Оркин В.Ф., Румянцева Е.В. и соавт. Случай поздней диагностики третичного сифилиса. Вестн. дерматол. венерол. 1998; (6): 54-55
  3. Мавлютова Г.И., Минуллин И.К., Бильдюк Е.В., Губайдуллин Р.М. Случай поздней диагностики третичного сифилиса. Вестн. дерматол. венерол. 2010; (2): 48-51
  4. Clark E.G., Danbolt N. The Oslo study of the natural history of untreated syphilis; an epidemiologic investigation based on a restudy of the Boeck-Bruusgaard material; a review and appraisal. J Chronic Dis1955; 2 (3): 311-344
  5. Санберг Д.Д. О сельском сифилисе. Протоколы Русского сифилидологического и дерматовенерологического общества. СПб., 1896. С. 46-48
  6. Чистяков М.А. О сифилисе в крестьянском населении. Санкт-Петербург, 1884
  7. Fenton K., Breban R., Vardavas R. et al. Infectious syphilis in high-income settings in the 21st century. The Lancet Infectious Diseases 2008; 8 (4): 244-253
  8. Revathi T.N., Bhat S., Asha G.S. Benign nodular tertiary syphilis: a rare presenting manifestation of HIV infection. Dermatol Online J 2011; 17 (2): 5.
  9. Tucker J.D., Cohen M.S. China's syphilis epidemic: epidemiology, proximate determinants of spread, and control responses. Curr Opin Infect Dis 2011; 24 (1): 50-55.
  10. Loza O., Patterson T.L., Rusch M. et al. Drug-related behaviors inde-pendently associated with syphilis infection among female sex workers in two Mexico-US border cities. Addiction 2010; 105 (8): 1448-1456.
  11. Righarts A.A., Simms I., Wallace L. et al. Syphilis surveillance and epidemiology in the United Kingdom. Euro Surveill 2004; 9 (12): 21-25.
  12. Hesketh T., Ye X., Zhu W. Syphilis in China: the great comeback. Emerg Health Threats J 2008; 1: e 6.
  13. Weinert L.S., Scheffel R.S., Zoratto G. et al. Cerebral syphilitic gumma in HIV-infected patients: case report and review. Int J STD AIDS 2008; 19 (1): 62-64.
  14. Morshed M.G., Lee M.K., Maguire J. et al. Neurosyphilitic gumma in a homosexual man with HIV infection confirmed by polymerase chain reaction. Int J STD AIDS 2008; 19 (8): 568-569.
  15. Régal L., Demaerel P., Dubois B. Cerebral syphilitic gumma in a human immunodeficiency virus-positive patient. Arch Neurol 2005; 62 (8): 1310-1311.
  16. Cataño J.C., Ramirez I.C. Syphilitic aortic aneurysm in a young HIV-infected man: case presentation. Case Rep Infect Dis 2011; 2011: 935271.
  17. Конюхова К.А., Григорьева Г.Н., Цветкова Г.М. Третичный сифилис. ЗППП 1998; (5): 42-43
  18. Kearns G., Pogrel M.A., Honda G. Intraoral tertiary syphilis (gumma) in a human immunodeficiency virus-positive man: a case report. J Oral Maxillofac Surg 1993; 51 (1): 85-88
  19. Gutierrez-Galhardo M.C., do Valle G.F., Sá F.C. et al. Clinical characteristics and evolution of syphilis in 24 HIV+ individuals in Rio de Janeiro, Brazil. Rev Inst Med trop S Paulo 2005; 47 (3): 153-157
  20. Dawson S., Evans B.A., Lawrence A.G. Benign tertiary syphilis and HIV infection. AIDS 1988; 2 (4): 315-316
  21. Борисенко К.К., Лосева О.К., Ибрагимов Р.А. и соавт. Сифилис третичный активный, множественные гуммы нижних конечностей. ИППП 1999; (4): 38-40
  22. Мисенко Д.Н., Прохоренков В.И., Чесноков А.Б., Прокопьева А.А. Случай активного третичного сифилиса полости рта. Клин. дерматол. венерол. 2013; (3): 51-53
  23. Chung G., Kantor G.R., Whipple S. Tertiary syphilis of the face. J Am Acad Dermatol 1991; 24: 832-835.
  24. Wu S.J., Nguyen E.Q., Nielsen T.A., Pellegrini A.E. Nodular tertiary syphilis mimicking granuloma annulare. J Am Acad Dermatol 2000; 42 (2): 378-380.
  25. Drobacheff C., Moulin T., Van Landuyt H. et al. [Cutaneous tertiary syphilis with neurological symptoms]. Ann Dermatol Venereol 1994; 121 (1): 34-36.
  26. Pereira T.M., Fernandes J.C., Vieira A.P., Basto A.S. Tertiary syphilis. Int J Dermatol 2007; 46 (11): 1192-1195.
  27. Andrade P., Mariano A., Figueiredo A. Solitary frontal ulcer: a syphilitic gumma. Dermatol Online J 2010; 16 (9): 5.
  28. Varela P., Alves R., Velho G. et al. Two recent cases of tertiary syphilis. Eur J Dermatol 1999; 9 (5): 371-373.
  29. Chudomirova K., Chapkanov A., Abadjieva T., Popov S. Gummatous cutaneous syphilis. Sex Transm Dis 2009; 36 (4): 239-240.
  30. Sekkat A., Sedrati O., Derdabi D. [La syphilis tertiaire cutanéo-muqueuse]. Ann Dermatol Venereol 1994; 121 (2): 146-151.
  31. Chakir K., Benchikhi H. [Granulome centro-facial révélant une syphilis tertiaire]. Pan Afr Med J 2013; 15: 82.
  32. Sule R.R., Deshpande S.G., Dharmadhikari N.J., Joshi V.R. Late cutaneous syphilis. Cutis 1997; 59 (3): 135-137.
  33. Bains M.K., Hosseini-Ardehali M. Palatal perforations: past and present. Two case reports and a literature review. Br Dent J 2005; 199 (5): 267-269.
  34. Фурнье А. Руководство к патологии и терапии сифилиса. Третичный период. СПб, 1903. 346 с
  35. Федеральные клинические рекомендации по ведению больных сифилисом. М, 2013. 40 с

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Copyright (c) 2015 Krasnoselskikh T.V., Mikheev G.N., Grigorian A.E., Yastrebov V.V., Sokolovskiy E.V.

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