Speaker Credentials
OMS-II
Speaker Credentials
BS
College
Dr. Kiran C. Patel College of Osteopathic Medicine, DO
Medical Specialty
Dermatology
Format
Poster
Start Date
November 2024
End Date
November 2024
Track
2
Abstract
Introduction Rupioid syphilis is an atypical, severe form of secondary syphilis caused by Treponema pallidum. Here, we present a rare case of a cutaneous manifestation of latent secondary syphilis in an HIV-infected patient. Case Description A 33 year old HIV-positive female presented with a two-month history of generalized, draining, verrucous, scaly plaques that first started on her abdomen as a papule. Physical examination revealed mildly tender, odorous plaques, as well as white plaques on the buccal mucosa. H/E stains demonstrated verrucous pseudoepitheliomatous squamous hyperplasia associated with lymphoplasmacytic infiltrate and interface changes. Lab results showed a reduction in CD4+ lymphocytes and an elevation in RPR and viral load, and negative for spirochetes. The patient endorsed a history of syphilis two years prior that was treated with a single IM benzathine penicillin 2.4 M IU injection. The final clinical diagnosis based on the clinical and laboratory findings was malignant syphilis, despite inconclusive biopsy results. Discussion This case depicts the unusual presentation of rupioid syphilis in a dermatology clinic. This atypical presentation includes cutaneous manifestations including nodular and ulcerative lesions affecting the trunk and extremities and laboratory findings lacking consistent spirochete detection. Moreover, there are serious systemic complications of latent syphilis, including neurosyphilis, gummatous syphilis, and cardiovascular syphilis. These astounding clinical implications coupled with the increasing incidence of syphilis the past few decades urge early diagnosis and adequate treatment. This noteworthy case exemplifies an unusual manifestation of syphilis that merits attention when evaluating patients with distinctive historical, cutaneous, and laboratory findings.
Included in
Rupioid Syphilis Case Report
Introduction Rupioid syphilis is an atypical, severe form of secondary syphilis caused by Treponema pallidum. Here, we present a rare case of a cutaneous manifestation of latent secondary syphilis in an HIV-infected patient. Case Description A 33 year old HIV-positive female presented with a two-month history of generalized, draining, verrucous, scaly plaques that first started on her abdomen as a papule. Physical examination revealed mildly tender, odorous plaques, as well as white plaques on the buccal mucosa. H/E stains demonstrated verrucous pseudoepitheliomatous squamous hyperplasia associated with lymphoplasmacytic infiltrate and interface changes. Lab results showed a reduction in CD4+ lymphocytes and an elevation in RPR and viral load, and negative for spirochetes. The patient endorsed a history of syphilis two years prior that was treated with a single IM benzathine penicillin 2.4 M IU injection. The final clinical diagnosis based on the clinical and laboratory findings was malignant syphilis, despite inconclusive biopsy results. Discussion This case depicts the unusual presentation of rupioid syphilis in a dermatology clinic. This atypical presentation includes cutaneous manifestations including nodular and ulcerative lesions affecting the trunk and extremities and laboratory findings lacking consistent spirochete detection. Moreover, there are serious systemic complications of latent syphilis, including neurosyphilis, gummatous syphilis, and cardiovascular syphilis. These astounding clinical implications coupled with the increasing incidence of syphilis the past few decades urge early diagnosis and adequate treatment. This noteworthy case exemplifies an unusual manifestation of syphilis that merits attention when evaluating patients with distinctive historical, cutaneous, and laboratory findings.