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e altera&#231;&#245;es discretas de enzimas hep&#225;ticas &#40;alanina aminotransferase&#44; 59 U&#47;L&#59; fosfatase alcalina&#44; 136 U&#47;L&#59; gamaglutamil transferase&#44; 174 U&#47;L&#41;&#46; A taxa de filtra&#231;&#227;o glomerular estimada havia diminu&#237;do 12&#37; em rela&#231;&#227;o &#224; linha basal &#40;93<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#41;&#46; Os testes sorol&#243;gicos para HIV 1&#47;2&#44; HTLV I&#47;II e hepatites B e C&#44; assim como a carga viral plasm&#225;tica do HIV&#8208;1 e RT&#8208;PCR para COVID&#8208;19&#44; foram negativos&#46; A tomografia computadorizada cerebral n&#227;o revelou anormalidades&#46; A an&#225;lise do l&#237;quido cefalorraquidiano &#40;LCR&#41; mostrou leve pleocitose linfoc&#237;tica&#44; n&#237;veis elevados de prote&#237;nas e hipoglicorraquia&#46; O VDRL do LCR mostrou ser n&#227;o reagente&#59; entretanto&#44; o teste de absor&#231;&#227;o de anticorpos trepon&#234;micos fluorescentes &#40;FTA&#8208;ABS&#44; do ingl&#234;s <span class="elsevierStyleItalic">fluorescent treponemal antibody absorption</span>&#41; IgG foi reagente &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; A avalia&#231;&#227;o oftalmol&#243;gica revelou papiledema no olho direito&#46; A histopatologia de biopsia de pele do tronco mostrou padr&#227;o de dermatite de interface associada a infiltrado linfoc&#237;tico perivascular e perianexial&#44; com raros plasm&#243;citos &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>A&#41;&#46; A an&#225;lise imuno&#8208;histoqu&#237;mica para <span class="elsevierStyleItalic">T&#46; pallidum</span> foi positiva &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">O paciente foi diagnosticado com s&#237;filis secund&#225;ria concomitante com les&#227;o prim&#225;ria e neuross&#237;filis inicial&#44; e recebeu penicilina G pot&#225;ssica intravenosa &#40;4 milh&#245;es UI de 4 em 4 horas por 14 dias&#41;&#46; Ap&#243;s o t&#233;rmino do tratamento de 14 dias&#44; a les&#227;o peniana estava curada&#44; e notou&#8208;se melhora evidente nas outras les&#245;es dermatol&#243;gicas e na paralisia facial&#44; com normaliza&#231;&#227;o dos n&#237;veis de enzimas hep&#225;ticas e da fun&#231;&#227;o renal&#46; Subsequentemente&#44; o esquema imunossupressor n&#227;o foi modificado&#46; Um m&#234;s ap&#243;s o tratamento de 14 dias&#44; o paciente estava completamente assintom&#225;tico&#46; Tr&#234;s meses ap&#243;s o tratamento&#44; o papiledema ainda estava em regress&#227;o&#46; No seguimento de 15 meses&#44; n&#227;o houve recidiva da s&#237;filis e o exame oftalmol&#243;gico n&#227;o mostrou mais papiledema&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> apresenta as respostas sorol&#243;gicas ao tratamento da s&#237;filis&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">O diagn&#243;stico foi de s&#237;filis prim&#225;ria&#8208;secund&#225;ria &#40;s&#237;filis inicial&#41;&#44; mesmo com o relato do paciente de aus&#234;ncia de atividade sexual nos &#250;ltimos tr&#234;s meses&#44; pois o paciente poderia ter omitido tal informa&#231;&#227;o&#44; e o quadro cl&#237;nico era t&#237;pico de les&#245;es nas fases prim&#225;ria e secund&#225;ria&#46; Pode&#8208;se questionar se a les&#227;o peniana era manifesta&#231;&#227;o da s&#237;filis prim&#225;ria ou da s&#237;filis secund&#225;ria&#46; Entretanto&#44; a les&#227;o peniana foi a primeira a aparecer&#44; clinicamente compat&#237;vel com cancro prim&#225;rio&#44; e as les&#245;es no corpo e nas palmas das m&#227;os e plantas dos p&#233;s&#44; t&#237;picas da s&#237;filis secund&#225;ria&#44; apareceram apenas alguns dias depois&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">O curso natural da s&#237;filis sexualmente adquirida tem fases bem definidas&#44; caracterizadas sequencialmente pela s&#237;filis prim&#225;ria&#44; secund&#225;ria&#44; latente e est&#225;gio terci&#225;rio &#40;em at&#233; 40&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> No entanto&#44; a apresenta&#231;&#227;o cl&#237;nica costuma ser at&#237;pica em popula&#231;&#245;es imunocomprometidas&#46; Em pessoas que vivem com HIV&#47;AIDS&#44; h&#225; coincid&#234;ncia entre as fases prim&#225;ria e secund&#225;ria&#44; r&#225;pida evolu&#231;&#227;o para a fase terci&#225;ria &#40;secundo&#8208;terciarismo&#41;&#44; ocorr&#234;ncia de m&#250;ltiplas les&#245;es prim&#225;rias&#44; s&#237;filis secund&#225;ria maligna&#44; envolvimento neurol&#243;gico e oftalmol&#243;gico inicial&#44; envolvimento de nervos cranianos&#44; al&#233;m de s&#237;filis g&#225;strica&#44; hep&#225;tica e pulmonar&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Foram identificados apenas seis relatos de s&#237;filis adquirida ap&#243;s TRx&#44; prevalecendo casos graves e disseminados&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#8211;9</span></a> Este caso corroborou o envolvimento hep&#225;tico&#44; neurol&#243;gico e oft&#225;lmico anteriormente descrito&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#8211;9</span></a> No entanto&#44; apresentou&#8208;se com os seguintes sintomas incomuns&#58; envolvimento prim&#225;rio e secund&#225;rio simult&#226;neo&#44; paralisia facial perif&#233;rica e VDRL falso&#8208;negativo no LCR&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Deve&#8208;se prestar aten&#231;&#227;o a essas apresenta&#231;&#245;es at&#237;picas em pacientes submetidos a TRx&#44; pois a s&#237;filis demonstrou ser um mimetizador ainda melhor em pacientes imunocomprometidos do que em pacientes imunocompetentes&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0045" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0050" class="elsevierStylePara elsevierViewall">Ana Claudia Athanasio Shwetz&#58; Elabora&#231;&#227;o do texto&#44; participa&#231;&#227;o efetiva na proped&#234;utica&#44; revis&#227;o de literatura&#44; revis&#227;o cr&#237;tica e aprova&#231;&#227;o do manuscrito&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Gabriel Berg de Almeida&#58; Elabora&#231;&#227;o do texto&#44; participa&#231;&#227;o efetiva na orienta&#231;&#227;o&#44; participa&#231;&#227;o efetiva na proped&#234;utica&#44; revis&#227;o de literatura&#44; revis&#227;o cr&#237;tica e aprova&#231;&#227;o do manuscrito&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Ricardo de Souza Cavalcante&#58; Elabora&#231;&#227;o do texto&#44; participa&#231;&#227;o efetiva na orienta&#231;&#227;o&#44; participa&#231;&#227;o efetiva na proped&#234;utica&#44; revis&#227;o de literatura&#44; revis&#227;o cr&#237;tica e aprova&#231;&#227;o do manuscrito&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Juliano Vilaverde Schmitt&#58; Elabora&#231;&#227;o do texto&#44; participa&#231;&#227;o efetiva na orienta&#231;&#227;o&#44; participa&#231;&#227;o efetiva na proped&#234;utica&#44; revis&#227;o de literatura&#44; revis&#227;o cr&#237;tica&#44; e aprova&#231;&#227;o do manuscrito&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Luciana Patr&#237;cia Fernandes Abbade&#58; Elabora&#231;&#227;o do texto&#44; participa&#231;&#227;o efetiva na orienta&#231;&#227;o&#44; participa&#231;&#227;o efetiva na proped&#234;utica&#44; revis&#227;o de literatura&#44; revis&#227;o cr&#237;tica e aprova&#231;&#227;o do manuscrito&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Ricardo Augusto Monteiro de Barros Almeida&#58; Elabora&#231;&#227;o do texto&#44; participa&#231;&#227;o efetiva na orienta&#231;&#227;o&#44; participa&#231;&#227;o efetiva na proped&#234;utica&#44; revis&#227;o de literatura&#44; revis&#227;o cr&#237;tica e aprova&#231;&#227;o do manuscrito&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0080" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Shwetz AC&#44; Almeida GB&#44; Cavalcante RS&#44; Schmitt JV&#44; Abbade LP&#44; Almeida RA&#46; Secondary syphilis concomitant with primary lesion and early neurosyphilis in a kidney transplant recipient&#46; An Bras Dermatol&#46; 2023&#59;98&#58;725&#8211;9&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">LCR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dois dias pr&#233;&#8208;tratamento</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">13 dias de tratamento</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">180 dias p&#243;s&#8208;tratamento</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aspecto do fluido&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t">Claro e incolor</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Claro e incolor</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Claro e incolor</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LEU &#40;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t">8</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Linf&#243;citos &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mon&#243;citos &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t">1</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neutr&#243;filos &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HEM &#40;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t">5</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t">15</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t">2</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prote&#237;na &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Glicose &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Propor&#231;&#227;o de glicose no soro&#47;LCR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;47</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;62</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VDRL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o reagente</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o reagente</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o reagente</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FTA&#8208;ABS &#40;IgM&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o reagente</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FTA&#8208;ABS &#40;IgG&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reagente</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Outros &#40;todos negativos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cultura bacteriana&#47;f&#250;ngica&#59; colora&#231;&#227;o pelo nanquim&#59; teste de aglutina&#231;&#227;o de l&#225;tex para ant&#237;geno criptoc&#243;ccico&#59; adenosina desaminase&#59; RT&#8208;PCR&#58; CMV&#44; VZV&#44; HSV&#8208;1&#44; HSV&#8208;2</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Soro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 meses pr&#233;&#8208;RTx</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 dias pr&#233;&#8208;tratamento</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 dias p&#243;s&#8208;tratamento</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VDRL &#40;titula&#231;&#227;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#58;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#58;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">156 dias p&#243;s&#8208;tratamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">212 dias p&#243;s&#8208;tratamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">338 dias p&#243;s&#8208;tratamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CLIA &#8211; teste trepon&#234;mico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o reagente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reagente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reagente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#58;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#58;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#58;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas do l&#237;quido cefalorraquidiano e dados sorol&#243;gicos do receptor de transplante renal</p>"
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    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:10 [
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              "referencia" => array:1 [
                0 => array:2 [
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;W&#46; Peeling"
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                  "host" => array:1 [
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            1 => array:3 [
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              "identificador" => "bib0070"
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Ballout"
                            1 => "J&#46;C&#46; Yombi"
                            2 => "Z&#46; Hassoun"
                            3 => "E&#46; Goffin"
                            4 => "N&#46; Kanaan"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ndtplus/sfn139"
                      "Revista" => array:6 [
                        "tituloSerie" => "NDT Plus&#46;"
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                        "link" => array:1 [
                          0 => array:2 [
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                        ]
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                ]
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            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neurosyphilis in a renal transplant patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Camarero-Temi&#241;o"
                            1 => "V&#46; Mercado-Valdivia"
                            2 => "M&#46;J&#46; Izquierdo-Ortiz"
                            3 => "J&#46;J&#46; Santos-Barajas"
                            4 => "B&#46; Hijazi-Prieto"
                            5 => "I&#46; S&#225;ez-Calero"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.3265/Nefrologia.pre2012.Nov.11698"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nefrologia&#46;"
                        "fecha" => "2013"
                        "volumen" => "33"
                        "paginaInicial" => "277"
                        "paginaFinal" => "279"
                        "link" => array:1 [
                          0 => array:2 [
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            5 => array:3 [
              "identificador" => "bib0080"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early syphilitic hepatitis after renal transplantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;C&#46; Johnson"
                            1 => "S&#46;J&#46; Norris"
                            2 => "G&#46;P&#46; Miller"
                            3 => "L&#46;D&#46; Scott"
                            4 => "S&#46; Sell"
                            5 => "B&#46;D&#46; Kahan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/infdis/158.1.236"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Infect Dis&#46;"
                        "fecha" => "1988"
                        "volumen" => "158"
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                          0 => array:2 [
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              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ocular syphilis in a kidney transplant recipient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46;A&#46; Romao"
                            1 => "V&#46;R&#46; Bolella"
                            2 => "M&#46;E&#46; Nardin"
                            3 => "M&#46;L&#46; Habib-Simao"
                            4 => "J&#46;M&#46; Furtado"
                            5 => "M&#46; Moyses-Neto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/S1678-9946201658046"
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Inst Med Trop Sao Paulo&#46;"
                        "fecha" => "2016"
                        "volumen" => "58"
                        "paginaInicial" => "46"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27253748"
                            "web" => "Medline"
                          ]
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            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The prozone phenomenon in secondary syphilis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Taniguchi"
                            1 => "K&#46; Osato"
                            2 => "T&#46; Hamada"
                          ]
                        ]
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Cartas ‐ Tropical/Infectoparasitária
Sífilis secundária concomitante com lesão primária e neurossífilis inicial em receptor de transplante renal
Ana Claudia Athanasio Shwetz, Gabriel Berg de Almeida, Ricardo de Souza Cavalcante, Juliano Vilaverde Schmitt, Luciana Patrícia Fernandes Abbade
Corresponding author
fernandes.abbade@unesp.br

Autor para correspondência.
, Ricardo Augusto Monteiro de Barros Almeida
Departamento de Infectologia, Dermatologia, Diagnóstico por Imagem e Radioterapia, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brasil
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de 24 anos&#44; deu entrada no pronto&#8208;socorro em julho de 2020 com &#250;lcera genital indolor havia 20 dias &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A&#41;&#46; Posteriormente&#44; surgiram m&#250;ltiplas p&#225;pulas eritematosas n&#227;o pruriginosas e indolores com descama&#231;&#227;o perif&#233;rica&#46; Essas p&#225;pulas tinham distribui&#231;&#227;o sim&#233;trica no tronco &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>B&#41;&#44; membros superiores e regi&#245;es palmoplantares &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>A&#41;&#46; O paciente apresentava&#44; ainda&#44; odinofagia e paralisia facial perif&#233;rica direita &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>B&#41;&#46; Havia sido submetido a TRx 18 meses antes da apresenta&#231;&#227;o&#46; A imunossupress&#227;o incluiu tacrolimus&#44; micofenolato de s&#243;dio e prednisona&#46; Referia ser heterossexual&#44; negava rela&#231;&#245;es sexuais nos tr&#234;s meses anteriores &#224; apresenta&#231;&#227;o ou qualquer epis&#243;dio anterior de s&#237;filis&#46; O teste de imunoensaio por quimioluminesc&#234;ncia &#40;CLIA&#44; do ingl&#234;s <span class="elsevierStyleItalic">chemiluminescence immunoassay</span>&#41; do receptor antes do TRx era n&#227;o reagente &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#44; assim como o teste s&#233;rico do VDRL &#40;do ingl&#234;s&#44; <span class="elsevierStyleItalic">Venereal Disease Research Laboratory</span>&#41; do doador falecido&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Na apresenta&#231;&#227;o&#44; a investiga&#231;&#227;o sorol&#243;gica mostrou VDRL &#40;1&#58;16&#41; e CLIA reagentes &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; Foram identificadas linfopenia &#40;880 linf&#243;citos&#47;mm<span class="elsevierStyleSup">3</span>&#41; e altera&#231;&#245;es discretas de enzimas hep&#225;ticas &#40;alanina aminotransferase&#44; 59 U&#47;L&#59; fosfatase alcalina&#44; 136 U&#47;L&#59; gamaglutamil transferase&#44; 174 U&#47;L&#41;&#46; A taxa de filtra&#231;&#227;o glomerular estimada havia diminu&#237;do 12&#37; em rela&#231;&#227;o &#224; linha basal &#40;93<span class="elsevierStyleHsp" style=""></span>mL&#47;min&#47;1&#44;73 m<span class="elsevierStyleSup">2</span>&#41;&#46; Os testes sorol&#243;gicos para HIV 1&#47;2&#44; HTLV I&#47;II e hepatites B e C&#44; assim como a carga viral plasm&#225;tica do HIV&#8208;1 e RT&#8208;PCR para COVID&#8208;19&#44; foram negativos&#46; A tomografia computadorizada cerebral n&#227;o revelou anormalidades&#46; A an&#225;lise do l&#237;quido cefalorraquidiano &#40;LCR&#41; mostrou leve pleocitose linfoc&#237;tica&#44; n&#237;veis elevados de prote&#237;nas e hipoglicorraquia&#46; O VDRL do LCR mostrou ser n&#227;o reagente&#59; entretanto&#44; o teste de absor&#231;&#227;o de anticorpos trepon&#234;micos fluorescentes &#40;FTA&#8208;ABS&#44; do ingl&#234;s <span class="elsevierStyleItalic">fluorescent treponemal antibody absorption</span>&#41; IgG foi reagente &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; A avalia&#231;&#227;o oftalmol&#243;gica revelou papiledema no olho direito&#46; A histopatologia de biopsia de pele do tronco mostrou padr&#227;o de dermatite de interface associada a infiltrado linfoc&#237;tico perivascular e perianexial&#44; com raros plasm&#243;citos &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>A&#41;&#46; A an&#225;lise imuno&#8208;histoqu&#237;mica para <span class="elsevierStyleItalic">T&#46; pallidum</span> foi positiva &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">O paciente foi diagnosticado com s&#237;filis secund&#225;ria concomitante com les&#227;o prim&#225;ria e neuross&#237;filis inicial&#44; e recebeu penicilina G pot&#225;ssica intravenosa &#40;4 milh&#245;es UI de 4 em 4 horas por 14 dias&#41;&#46; Ap&#243;s o t&#233;rmino do tratamento de 14 dias&#44; a les&#227;o peniana estava curada&#44; e notou&#8208;se melhora evidente nas outras les&#245;es dermatol&#243;gicas e na paralisia facial&#44; com normaliza&#231;&#227;o dos n&#237;veis de enzimas hep&#225;ticas e da fun&#231;&#227;o renal&#46; Subsequentemente&#44; o esquema imunossupressor n&#227;o foi modificado&#46; Um m&#234;s ap&#243;s o tratamento de 14 dias&#44; o paciente estava completamente assintom&#225;tico&#46; Tr&#234;s meses ap&#243;s o tratamento&#44; o papiledema ainda estava em regress&#227;o&#46; No seguimento de 15 meses&#44; n&#227;o houve recidiva da s&#237;filis e o exame oftalmol&#243;gico n&#227;o mostrou mais papiledema&#46; A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> apresenta as respostas sorol&#243;gicas ao tratamento da s&#237;filis&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">O diagn&#243;stico foi de s&#237;filis prim&#225;ria&#8208;secund&#225;ria &#40;s&#237;filis inicial&#41;&#44; mesmo com o relato do paciente de aus&#234;ncia de atividade sexual nos &#250;ltimos tr&#234;s meses&#44; pois o paciente poderia ter omitido tal informa&#231;&#227;o&#44; e o quadro cl&#237;nico era t&#237;pico de les&#245;es nas fases prim&#225;ria e secund&#225;ria&#46; Pode&#8208;se questionar se a les&#227;o peniana era manifesta&#231;&#227;o da s&#237;filis prim&#225;ria ou da s&#237;filis secund&#225;ria&#46; Entretanto&#44; a les&#227;o peniana foi a primeira a aparecer&#44; clinicamente compat&#237;vel com cancro prim&#225;rio&#44; e as les&#245;es no corpo e nas palmas das m&#227;os e plantas dos p&#233;s&#44; t&#237;picas da s&#237;filis secund&#225;ria&#44; apareceram apenas alguns dias depois&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">O curso natural da s&#237;filis sexualmente adquirida tem fases bem definidas&#44; caracterizadas sequencialmente pela s&#237;filis prim&#225;ria&#44; secund&#225;ria&#44; latente e est&#225;gio terci&#225;rio &#40;em at&#233; 40&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> No entanto&#44; a apresenta&#231;&#227;o cl&#237;nica costuma ser at&#237;pica em popula&#231;&#245;es imunocomprometidas&#46; Em pessoas que vivem com HIV&#47;AIDS&#44; h&#225; coincid&#234;ncia entre as fases prim&#225;ria e secund&#225;ria&#44; r&#225;pida evolu&#231;&#227;o para a fase terci&#225;ria &#40;secundo&#8208;terciarismo&#41;&#44; ocorr&#234;ncia de m&#250;ltiplas les&#245;es prim&#225;rias&#44; s&#237;filis secund&#225;ria maligna&#44; envolvimento neurol&#243;gico e oftalmol&#243;gico inicial&#44; envolvimento de nervos cranianos&#44; al&#233;m de s&#237;filis g&#225;strica&#44; hep&#225;tica e pulmonar&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Foram identificados apenas seis relatos de s&#237;filis adquirida ap&#243;s TRx&#44; prevalecendo casos graves e disseminados&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#8211;9</span></a> Este caso corroborou o envolvimento hep&#225;tico&#44; neurol&#243;gico e oft&#225;lmico anteriormente descrito&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#8211;9</span></a> No entanto&#44; apresentou&#8208;se com os seguintes sintomas incomuns&#58; envolvimento prim&#225;rio e secund&#225;rio simult&#226;neo&#44; paralisia facial perif&#233;rica e VDRL falso&#8208;negativo no LCR&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Deve&#8208;se prestar aten&#231;&#227;o a essas apresenta&#231;&#245;es at&#237;picas em pacientes submetidos a TRx&#44; pois a s&#237;filis demonstrou ser um mimetizador ainda melhor em pacientes imunocomprometidos do que em pacientes imunocompetentes&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0045" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0050" class="elsevierStylePara elsevierViewall">Ana Claudia Athanasio Shwetz&#58; Elabora&#231;&#227;o do texto&#44; participa&#231;&#227;o efetiva na proped&#234;utica&#44; revis&#227;o de literatura&#44; revis&#227;o cr&#237;tica e aprova&#231;&#227;o do manuscrito&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Gabriel Berg de Almeida&#58; Elabora&#231;&#227;o do texto&#44; participa&#231;&#227;o efetiva na orienta&#231;&#227;o&#44; participa&#231;&#227;o efetiva na proped&#234;utica&#44; revis&#227;o de literatura&#44; revis&#227;o cr&#237;tica e aprova&#231;&#227;o do manuscrito&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Ricardo de Souza Cavalcante&#58; Elabora&#231;&#227;o do texto&#44; participa&#231;&#227;o efetiva na orienta&#231;&#227;o&#44; participa&#231;&#227;o efetiva na proped&#234;utica&#44; revis&#227;o de literatura&#44; revis&#227;o cr&#237;tica e aprova&#231;&#227;o do manuscrito&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Juliano Vilaverde Schmitt&#58; Elabora&#231;&#227;o do texto&#44; participa&#231;&#227;o efetiva na orienta&#231;&#227;o&#44; participa&#231;&#227;o efetiva na proped&#234;utica&#44; revis&#227;o de literatura&#44; revis&#227;o cr&#237;tica&#44; e aprova&#231;&#227;o do manuscrito&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Luciana Patr&#237;cia Fernandes Abbade&#58; Elabora&#231;&#227;o do texto&#44; participa&#231;&#227;o efetiva na orienta&#231;&#227;o&#44; participa&#231;&#227;o efetiva na proped&#234;utica&#44; revis&#227;o de literatura&#44; revis&#227;o cr&#237;tica e aprova&#231;&#227;o do manuscrito&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Ricardo Augusto Monteiro de Barros Almeida&#58; Elabora&#231;&#227;o do texto&#44; participa&#231;&#227;o efetiva na orienta&#231;&#227;o&#44; participa&#231;&#227;o efetiva na proped&#234;utica&#44; revis&#227;o de literatura&#44; revis&#227;o cr&#237;tica e aprova&#231;&#227;o do manuscrito&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0080" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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                  \t\t\t\t">Linf&#243;citos &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mon&#243;citos &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neutr&#243;filos &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HEM &#40;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prote&#237;na &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Glicose &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Propor&#231;&#227;o de glicose no soro&#47;LCR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;47</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;62</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VDRL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o reagente</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o reagente</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o reagente</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FTA&#8208;ABS &#40;IgM&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o reagente</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FTA&#8208;ABS &#40;IgG&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reagente</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Outros &#40;todos negativos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cultura bacteriana&#47;f&#250;ngica&#59; colora&#231;&#227;o pelo nanquim&#59; teste de aglutina&#231;&#227;o de l&#225;tex para ant&#237;geno criptoc&#243;ccico&#59; adenosina desaminase&#59; RT&#8208;PCR&#58; CMV&#44; VZV&#44; HSV&#8208;1&#44; HSV&#8208;2</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Soro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 meses pr&#233;&#8208;RTx</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 dias pr&#233;&#8208;tratamento</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 dias p&#243;s&#8208;tratamento</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VDRL &#40;titula&#231;&#227;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#58;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#58;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">156 dias p&#243;s&#8208;tratamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">212 dias p&#243;s&#8208;tratamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">338 dias p&#243;s&#8208;tratamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CLIA &#8211; teste trepon&#234;mico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o reagente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reagente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Reagente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#58;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#58;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#58;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas do l&#237;quido cefalorraquidiano e dados sorol&#243;gicos do receptor de transplante renal</p>"
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      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;W&#46; Peeling"
                            1 => "D&#46; Mabey"
                            2 => "M&#46;L&#46; Kamb"
                            3 => "X&#46;S&#46; Chen"
                            4 => "J&#46;D&#46; Radolf"
                            5 => "A&#46;S&#46; Benzaken"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Syphilis&#46; Nat Rev Dis Primers"
                        "fecha" => "2017"
                        "volumen" => "3"
                        "paginaInicial" => "17073"
                      ]
                    ]
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            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Asymptomatic transmission of treponema pallidum &#40;syphilis&#41; through deceased donor liver transplantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L&#46; Tariciotti"
                            1 => "I&#46; Das"
                            2 => "L&#46; Dori"
                            3 => "M&#46;T&#46; Perera"
                            4 => "S&#46;R&#46; Bramhall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1399-3062.2012.00745.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Transpl Infect Dis&#46;"
                        "fecha" => "2012"
                        "volumen" => "14"
                        "paginaInicial" => "321"
                        "paginaFinal" => "325"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22624823"
                            "web" => "Medline"
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                        ]
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                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "who&#46;int &#91;Internet&#93;&#46; World Health Organization&#46; Report on global sexually transmitted infection surveillance 2018&#46; &#91;acesso em 25 jan&#46; 2022&#93;&#46; Dispon&#237;vel em&#58; &#60;<a target="_blank" href="https://www.who.int/publications/i/item/9789241565691">https&#58;&#47;&#47;www&#46;who&#46;int&#47;publications&#47;i&#47;item&#47;9789241565691</a>&#62;&#46;"
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              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Secondary syphilis after renal transplantation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Ballout"
                            1 => "J&#46;C&#46; Yombi"
                            2 => "Z&#46; Hassoun"
                            3 => "E&#46; Goffin"
                            4 => "N&#46; Kanaan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ndtplus/sfn139"
                      "Revista" => array:6 [
                        "tituloSerie" => "NDT Plus&#46;"
                        "fecha" => "2008"
                        "volumen" => "1"
                        "paginaInicial" => "442"
                        "paginaFinal" => "444"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28657001"
                            "web" => "Medline"
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                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neurosyphilis in a renal transplant patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Camarero-Temi&#241;o"
                            1 => "V&#46; Mercado-Valdivia"
                            2 => "M&#46;J&#46; Izquierdo-Ortiz"
                            3 => "J&#46;J&#46; Santos-Barajas"
                            4 => "B&#46; Hijazi-Prieto"
                            5 => "I&#46; S&#225;ez-Calero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3265/Nefrologia.pre2012.Nov.11698"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nefrologia&#46;"
                        "fecha" => "2013"
                        "volumen" => "33"
                        "paginaInicial" => "277"
                        "paginaFinal" => "279"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23511767"
                            "web" => "Medline"
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Article information
ISSN: 26662752
Original language: Portuguese
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