CME INDIA Case Presentation by Dr Sanjeev Kapoor, Faridabad.
CME INDIA Case Study
Case:
30-year-old male, donated blood and found HIV POSITIVE and VDRL positive. History of multiple contacts since 8-9 years.
About 6 months ago, had history of penile chancre.
Since 2-3 months he developed these non-pruritic, maculopapular lesions on soles and palms, no oral lesions.
TPHA test sent, HIV VIRAL LOAD awaited.
I think these are lesions of secondary syphilis.
I don’t remember having seen any pt of secondary syphilis in last 25- 30 years.
CME INDIA Discussion:
Dr Amit Kumar, Dermatologist, Ranchi: Sir are the lesions localised to palms and soles only??
Dr Sanjeev Kapoor, Faridabad: Yes
Dr Amit Kumar, Dermatologist, Ranchi: Sir in secondary syphilis generally the lesions are having generalised distribution, the localised variants are less likely but might occur
All said if no other cause is apparent treat the case as secondary syphilis, as it was once told syphilis is the great mimicker
Dr Ravishankar Dwivedi, Dermatologist, Ranchi: Presentation not classical S2 , but then it’s rare to see classical s2 these days because of otc antibiotics leading to partial/ incomplete treatment. Syphilis is a very sensitive microorganisms and responds, although partially to quite a few antibiotics. Few of the lesions are papules and one lesion on zoom and close inspection showed fine collaratre of scaling.
Will go with S2 and treat accordingly.
Addisonian pigmentation will also have mucosal involvement and affect fexures and trunk.
Dr Amit Kumar, Dermatologist, Ranchi: I agree sir…
CME INDIA Learning Points:
- Clinical criteria for recognition of secondary syphilis Generalized eruptions, especially if indolent, associated with generalized lymphadenopathy and otherwise vague signs of disease
- Eruptions that are universal, with the exception of macular rashes, and symmetrically distributed, almost always involving the face and forehead (individual lesions tend to be indurated; the color may vary considerably, most often presenting as a subdued red rather than a bright red lesion)
- Macular eruptions highly associated with papules on the genitalia or within the oral cavity Papular lesions on the palms of the hands or the soles of the feet and, in the absence of dermatitis, elsewhere on the body and involvement of the genitalia Generalized macular or papular lesions that persist for more than 1 week and are associated with a sore throat
- Generalized pustular or follicular lesions in the absence of oral and genitalia involvement Vesicular lesions, which, although uncommon, are not rare in darker skinned subjects
- Secondary syphilitic lesions, which tend to disappear without leaving permanent scars (depigmentary changes, although infrequent, tend to be permanent, whereas hyperpigmentation changes are not) Generalized lymphadenopathy, uniformly associated with secondary syphilis
(CLINICAL MICROBIOLOGY REVIEWS, Jan. 2005, p. 205–216 Vol. 18, No. 1 0893-8512/05/$08.000 doi:10.1128/CMR.18.1.205–216.2005)
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