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Images in Clinical Practice
ARTICLE IN PRESS
doi:
10.25259/IJDVL_108_2021

Malignant syphilis

Dermatology Service, Ramon y Cajal University Hospital, IRYCIS, Madrid, Spain
Dermatology Service, Jiménez Diaz Foundation University Hospital, Madrid, Spain
Corresponding author: Dr. Ana Melian-Olivera, Dermatology Service, Ramon y Cajal University Hospital, Carretera Colmenar, Viejo km 9.100, 28034 Madrid, Spain anamelianolivera@gmail.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Olivera AM, Cauhe JJ, Martinez CM. Malignant syphilis. Indian J Dermatol Venereol Leprol, doi: 10.25259/IJDVL_108_2021.

A 29-year-old woman, a known case of HIV, presented with a three-week history of fever and mucocutaneous lesions. Cutaneous examination revealed generalized scattered erythematous papules, with a necrotic eschar [Figure 1] and peripheral Biett collarette [Figure 2].

Figure 1:: Multiple erythematous papules and plaques, some of them covered with a central necrotic eschar present on the trunk and bilaterally on the upper limbs
Figure 2:: White rings of scales encircling a central erythematous crust (Biett collarette)

HIV viral load was 4.95 log and total CD4 lymphocyte count was 23 cells/mm3. Tests for syphilis showed a positive result for rapid plasma reagin test (titre of 1:16), Treponema pallidum hemagglutination assay and enzyme immunoassay test, consistent with the diagnosis of malignant syphilis. A single dose of intramuscular benzathine penicillin 2.4 million units was administered and the lesions resolved within a month with residual scars. A Jarisch-Herxheimer reaction occurred, which resolved with antipyretics. Our case fulfilled the Fisher’s criteria except for the absence of high titre serologic test, due to prozone phenomenon.

Declaration of patient consent

The patient's consent is not required as the patient's identity is not disclosed or compromised.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


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