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Late cutaneous syphilis has become a rarity as a result of effective treatment of early and latent syphilis with antibiotics. Superficial nodular lesions of late cutaneous syphilis should be differentiated from conditions including sarcoidosis, leprosy, lupus vulgaris, and granuloma annulare. We report the case of a 50-year-old woman with superficial nodular lesions of late cutaneous syphilis.
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A man had widespread, noduloulcerative syphilitic lesions that appeared, chronologically, during the "secondary" stage of syphilis. There were no systemic manifestations of the disease, except for possible periostitis. The darkfield examination and spinal fluid examinations were negative for syphilis. It is suggested that the term "malignant" syphilis should be discarded in favor of nonduloulcerative cutaneous syphilis.
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We report two syphilitic cases of indeterminable duration. The dramatic cutaneous lesions of the female patient, compatible with secondary-tertiary syphilis associated with a positive VDRL reaction in CSF together with the criteria of neurosyphilis in her male companion (despite normal TPHA and IgG indices), led us to treat both of them in an optimal way. The clinical and serological evolution was favourable.
We present a case of a patient coinfected with syphilis and the human immunodeficiency virus (HIV) who had unusual and severe cutaneous ulceration. The profound immune defects associated with HIV may lead to an altered clinical presentation and a more aggressive course in patients infected with Treponema pallidum. Despite non-confirmatory histological findings, we feel our patient's cutaneous ulcers probably represent superficial gummata, which have failed to resolve completely following currently accepted high-dose antisyphilis chemotherapy.
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INTRODUCTION: The tertiary cutaneous syphilis is now extremely rare. We report a case of tubercular cutaneous syphilis associated with neurological dysfunction. We emphasize the difficulties to interpret serologic and CSF tests for the diagnosis of neurosyphilis. CASE REPORT: A 63 year-old-woman had nodular, purplish and painless cutaneous lesions on forehead and forearm for 6 months. The biopsy showed a dermohypodermic lymphoplasmocytic granuloma, without necrosis, with endothelitis. Syphilis serologic tests were positive: VDRL = 512 U; TPHA = 40,960 U; FTA abs: IgG = 72,000 U; IgM = 1,350 U; Nelson test = 100 p. 100 (1,200 U). HIV test was negative. There was a past history of a positive syphilis serologic test when the patient was 20-year-old. The patient complained of shaking and her family spoke of gradual mental deterioration and behaviour troubles. The neurological examination showed a major frontal syndrome, cerebellar dysfunction with dysarthria and a major labial and lingual tremor. There is no lymphocytosis nor increased protein in the CSF; VDRL test was negative, TPHA test was positive, FTA abs = 4,000 U (IgG), and TPHA was increased. Penicillin G 16 millions units/day was given intravenously for 20 days; a slow increase was made in association with steroids at the beginning. The cutaneous lesions regressed in 14 days, but the neurologic state did not change. Six months later, there was still no IgM, TPHA decreased and VDRL was unchanged. DISCUSSION: While the diagnosis of tertiary cutaneous syphilis was correct, the neurological abnormalities are difficult to classify. The symptoms were those of general paresis, but there is no argument favouring biological CSF activity (no increase in protein or lymphocytosis, negative VDRL). Nevertheless, in the context of very positive serologic tests and tertiary cutaneous syphilis, we treated this case as a neurological syphilis. The treatment regimen and the need of current cures are still under discussion.
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