Tropical/Infectoparasitary Dermatology
Malignant syphilis in a patient with acquired human immunodeficiency virus (HIV) infection
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(A), Before acitretin treatment. Big comedo-like openings (300 to 500 microns) with a central hyperkeratotic structure, surrounded by a whitish scaling halo. (B), After acitretin treatment. Few white shiny clods with a pinkish homogeneous background.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Catalina Silva-Hirschberg, Raúl Cabrera, María Paz Rollán, Alex Castro" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Catalina" "apellidos" => "Silva-Hirschberg" ] 1 => array:2 [ "nombre" => "Raúl" "apellidos" => "Cabrera" ] 2 => array:2 [ "nombre" => "María Paz" "apellidos" => "Rollán" ] 3 => array:2 [ "nombre" => "Alex" "apellidos" => "Castro" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S2666275222001588" "doi" => "10.1016/j.abdp.2021.05.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275222001588?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059622001313?idApp=UINPBA00008Z" "url" => "/03650596/0000009700000005/v1_202208290604/S0365059622001313/v1_202208290604/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0365059622001167" "issn" => "03650596" "doi" => "10.1016/j.abd.2021.10.005" "estado" => "S300" "fechaPublicacion" => "2022-09-01" "aid" => "578" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "crp" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Tropical/Infectoparasitary Dermatology</span>" "titulo" => "Kerion celsi caused by <span class="elsevierStyleItalic">Trichophyton tonsurans</span> in an adult" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "637" "paginaFinal" => "640" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1086 "Ancho" => 2508 "Tamanyo" => 234879 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0100" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Trichophyton tonsurans.</span> (A), Microbiological culture. (B), Thin and septate hyphae with chlamydoconidia and multiple conidia arranged in alternate ways and mirrored.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jacqueline Paulina Aguirre Sotelo, Víctor Manuel Tarango Martinez, Lucio Vera Cabrera" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Jacqueline Paulina" "apellidos" => "Aguirre Sotelo" ] 1 => array:2 [ "nombre" => "Víctor Manuel" "apellidos" => "Tarango Martinez" ] 2 => array:2 [ "nombre" => "Lucio" "apellidos" => "Vera Cabrera" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S266627522200145X" "doi" => "10.1016/j.abdp.2022.07.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S266627522200145X?idApp=UINPBA00008Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059622001167?idApp=UINPBA00008Z" "url" => "/03650596/0000009700000005/v1_202208290604/S0365059622001167/v1_202208290604/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Tropical/Infectoparasitary Dermatology</span>" "titulo" => "Malignant syphilis in a patient with acquired human immunodeficiency virus (HIV) infection" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "641" "paginaFinal" => "643" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ana Sofia Pereira, Aluixa Lozada, Ana Filipe Monteiro" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Ana Sofia" "apellidos" => "Pereira" "email" => array:1 [ 0 => "sfigpereira@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Aluixa" "apellidos" => "Lozada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Ana Filipe" "apellidos" => "Monteiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Dermatovenereology Service, Hospital de Santarém, Santarém, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Anatomopathological Service, Hospital de Santarém, Santarém, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Dermatovenereology Service, Hospital Garcia de Orta, Almada, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1334 "Ancho" => 3175 "Tamanyo" => 316473 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical aspect of the lesions (A) initial erythematous-squamous papules, (B) ulcerated plaques on the trunk (C) lesions covered with rupioid crusts at higher magnification.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 57-year-old human immunodeficiency virus (HIV) positive patient came to the Department of Dermatology due to a symmetrical and generalized dermatosis consisting of erythematous-squamous papules with one-month evolution (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), which gradually progressed to painful ulcerated plaques and nodules, some covered with lamellar and adherent crusts (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B‒C). The lesions were found on the scalp, face, trunk and also on the limbs. The palms, soles and mucous membranes were spared. The patient also reported fever, night sweats, and non-quantified weight loss in the previous weeks. He denied having risky sexual behaviors and declared having had a single sexual partner in the last 10 years.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The physical examination revealed bilateral inguinal adenomegaly, with no genital or perineal lesions. The neurological examination was normal.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The laboratory tests revealed a viral load of <20 copies/μL and a CD4+ cell count of 507 μL. The VDRL (Venereal Disease Research Laboratory) test was positive at 1:32 dilutions, as was the RPR (Rapid Plasma Reagin), at a titer of 1:128.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A skin biopsy was performed, which revealed a lymphohistiocytic infiltrate in the superficial dermis, and no plasma cells or eosinophils were observed.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Immunohistochemistry for spirochetes showed the presence of numerous ‘corkscrew-shaped’ microorganisms, compatible with <span class="elsevierStyleItalic">Treponema pallidum</span> (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The diagnosis of malignant syphilis was established and an intramuscular injection of benzathine penicillin G 2.4 MU was administered once a week, for three weeks. There was no Jarisch-Herxheimer (JH) reaction. The skin lesions gradually resolved, with residual hypopigmented scars.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Malignant syphilis (MS), also known as lues maligna or rupioid syphilis, is an uncommon form of secondary syphilis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Co-infection with HIV seems to be an important predisposing factor for MS, as these patients are 60-fold more likely to have this form of syphilis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Low CD4 counts may also favor MS, as most patients with HIV and MS have CD4 counts <500 cells/μL.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, there have been reported cases of MS in immunocompetent individuals,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> as well as in HIV-positive individuals with normal CD4 counts,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> as the patient described in the present case.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The classic clinical presentation of MS consists of squamous or crusted papules and plaques that become ulcerated or necrotic.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Due to the nonspecificity of the lesions, the differential diagnosis must include several entities, such as pyoderma gangrenosum, vasculitis, lymphoma, pityriasis lichenoides, erythema necrotisans and ecthyma gangrenosum.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The criteria developed in 1969 and used to the present day to aid in the diagnosis of MS include (1) Compatible clinical and microscopic aspects; (2) High serological titer for syphilis; (3) Severe JH reaction; and (4) Excellent response to antibiotic therapy.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In the present case, the diagnosis of MS was confirmed by the suggestive clinical condition, the positive VDRL and RPR tests, and the rapid resolution with the administration of penicillin. Additionally, the identification of <span class="elsevierStyleItalic">Treponema pallidum</span> by immunohistochemistry was crucial, given the nonspecificity of the histological findings, namely the absence of plasma cells.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Although uncommon, MS is a clinical entity that should be promptly recognized by dermatologists and general practitioners, as its early diagnosis and treatment result in less morbidity and better control of the dissemination of the infection.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial support</span><p id="par0070" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Authors' contributions</span><p id="par0075" class="elsevierStylePara elsevierViewall">Ana Sofia Pereira: Drafting and editing of the manuscript; literature search; approval of the final version of the manuscript.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Aluixa Lozada: Analysis and interpretation of data; approval of the final version of the manuscript.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Ana Filipe Monteiro: Critical review of the content; approval of the final version of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:3 [ "identificador" => "xres1763872" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1551041" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors' contributions" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-09-07" "fechaAceptado" => "2021-11-10" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1551041" "palabras" => array:3 [ 0 => "HIV" 1 => "Syphilis" 2 => "<span class="elsevierStyleItalic">Treponema pallidum</span>" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Malignant syphilis is an uncommon variant of syphilis, most often (but not always) found in immunosuppressed individuals. This report describes the case of a 57-year-old man, infected with the acquired human immunodeficiency virus (HIV), with a generalized picture of erythematous-squamous papules that rapidly progressed to painful and ulcerated plaques and nodules, some covered with a black rupioid crust. The analytical study performed revealed positive VDRL (Venereal Disease Research Laboratory) and RPR (Rapid Plasma Reagin). The skin biopsy was nonspecific; however, the immunohistochemical analysis disclosed the presence of spirochetes. The patient was then treated with benzathine penicillin G 2.4 MU once a week IM for three weeks, with progressive resolution of the lesions. Considering its rarity, this atypical form of syphilis that needs to be known to better recognize its clinical presentation and provide more prompt treatment to patients.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Hospital de Santarém, Santarém, Portugal.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1334 "Ancho" => 3175 "Tamanyo" => 316473 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical aspect of the lesions (A) initial erythematous-squamous papules, (B) ulcerated plaques on the trunk (C) lesions covered with rupioid crusts at higher magnification.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1133 "Ancho" => 1508 "Tamanyo" => 237161 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemical examination positive for <span class="elsevierStyleItalic">Treponema pallidum</span> (×630).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sífilis maligna: revisión sistemática de los casos publicados entre los anos 2014–2018" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "O. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
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| 2024 Fevereiro | 173 | 92 | 265 |
| 2024 Janeiro | 153 | 58 | 211 |
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| 2023 Novembro | 208 | 85 | 293 |
| 2023 Outubro | 161 | 84 | 245 |
| 2023 Setembro | 164 | 91 | 255 |
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| 2023 Janeiro | 49 | 47 | 96 |
| 2022 Dezembro | 80 | 33 | 113 |
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