Case report of a man with HIV presenting with malignant syphilis
Myong Gyu Kim
A B * , Vasanth Kamath A C , Marianne Martinello B D and Kristen Overton A B
A School of Clinical Medicine, UNSW Sydney, Kensington, Sydney, NSW, Australia.
B Department of Infectious Diseases, Prince of Wales Hospital, Randwick, Sydney, NSW, Australia.
C Department of Anatomical Pathology, Prince of Wales Hospital, Randwick, Sydney, NSW, Australia.
D Kirby Institute, UNSW Sydney, Kensington, NSW, Australia.
Sexual Health 20(1) 83-86 https://doi.org/10.1071/SH22161
Submitted: 25 September 2022 Accepted: 22 November 2022 Published: 13 December 2022
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: Malignant syphilis is a rare manifestation of secondary syphilis and is commonly associated with human immunodeficiency virus coinfection. It can present with multiorgan involvement, which poses a diagnostic dilemma to clinicians.
Methods: We report a case of a middle aged male who presented with near complete vision loss in his right eye with initial concern for fungal endophthalmitis due to his injecting drug use history. He concurrently had right cheek and forearm ulcerative plaques.
Results: He was diagnosed with disseminated syphilis following the punch biopsy of his right cheek, with positive Treponema pallidum result on polymerase chain reaction and identification of spirochaetes on immunostaining from histopathology.
Conclusions: We present the epidemiology of syphilis in Australia and highlight the importance of testing for common sexually transmitted diseases within the emergence of the monkeypox outbreak.
Keywords: endophthalmitis, histopathology, human immunodeficiency virus (HIV), monkeypox, polymerase chain reaction (PCR), skin lesion, syphilis, uveitis.
References
[1] Shulkin D, Tripoli L, Abell E. Lues maligna in a patient with human immunodeficiency virus infection. Am J Med 1988; 85 425–7.| Lues maligna in a patient with human immunodeficiency virus infection.Crossref | GoogleScholarGoogle Scholar |
[2] Tucker JD, Shah S, Jarell AD, Tsai KY, Zembowicz A, Kroshinsky D. Lues maligna in early HIV infection case report and review of the literature. Sex Transm Dis 2009; 36 512–4.
| Lues maligna in early HIV infection case report and review of the literature.Crossref | GoogleScholarGoogle Scholar |
[3] Held JL, Ross M, Beltrani M, Kohn SR, Grossman ME. Noduloulcerative or “malignant” syphilis occurring in an otherwise healthy woman: report and review of a dramatic dermatosis. Cutis 1990; 45 119–22.
[4] Cid PM, Cudós ES, Zamora Vargas FX, Merino MJB, Pinto PH. Pathologically confirmed malignant syphilis using immunohistochemical staining: report of 3 cases and review of the literature. Sex Transm Dis 2014; 41 94–7.
| Pathologically confirmed malignant syphilis using immunohistochemical staining: report of 3 cases and review of the literature.Crossref | GoogleScholarGoogle Scholar |
[5] Tucker JD, Li JZ, Robbins GK, et al. Ocular syphilis among HIV-infected patients: a systematic analysis of the literature. Sex Transm Infect 2011; 87 4–8.
| Ocular syphilis among HIV-infected patients: a systematic analysis of the literature.Crossref | GoogleScholarGoogle Scholar |
[6] Lee SY, Cheng V, Rodger D, Rao N. Clinical and laboratory characteristics of ocular syphilis: a new face in the era of HIV co-infection. J Ophthalmic Inflamm Infect 2015; 5 26
| Clinical and laboratory characteristics of ocular syphilis: a new face in the era of HIV co-infection.Crossref | GoogleScholarGoogle Scholar |
[7] More A, Sen A, Kohli G, Shenoy P, Gupta A. Positive syphilis serology in a case of endogenous candida endophthalmitis posing a diagnostic dilemma. Indian J Ophthalmol Case Rep 2021; 1 561–3.
| Positive syphilis serology in a case of endogenous candida endophthalmitis posing a diagnostic dilemma.Crossref | GoogleScholarGoogle Scholar |
[8] Zhang T, Zhu Y, Xu G. Clinical features and treatments of syphilitic uveitis: a systematic review and meta-analysis. J Ophthalmol 2017; 2017 6594849
| Clinical features and treatments of syphilitic uveitis: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |
[9] Bragazzi NL, Kong JD, Mahroum N, Tsigalou C, Khamisy-Farah R, Converti M, Wu J. Epidemiological trends and clinical features of the ongoing monkeypox epidemic: a preliminary pooled data analysis and literature review. J Med Virol 2022; 95 e27931
| Epidemiological trends and clinical features of the ongoing monkeypox epidemic: a preliminary pooled data analysis and literature review.Crossref | GoogleScholarGoogle Scholar |
[10] Kojima N, Klausner JD. An update on the global epidemiology of syphilis. Curr Epidemiol Rep 2018; 5 24–38.
| An update on the global epidemiology of syphilis.Crossref | GoogleScholarGoogle Scholar |
[11] NSW Health. Notifiable Conditions Information Management System (NCIMS). Communicable Diseases Branch and Centre for Epidemiology and Evidence, NSW Health, 2022.
[12] Yan X, Wang X, Zhang X, Wang L, Zhang B, Jia Z. The epidemic of sexually transmitted diseases under the influence of COVID-19 in China. Front Public Health 2021; 9 737817
| The epidemic of sexually transmitted diseases under the influence of COVID-19 in China.Crossref | GoogleScholarGoogle Scholar |
