Malignant syphilis requiring differentiation from Kaposi's sarcoma
Mieko Tokano,
Norihito Tarumoto,
Kazuo Imai,
Hiroshi Yamaguchi,
Masaaki Takeji,
Fumito Inayoshi,
Keita Okamoto,
Nobuhito Okumura,
Shigefumi Maesaki
Affiliations
Mieko Tokano
Department of Infectious Disease and Infection Control, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan; Department of Allergy and Immunology, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
Norihito Tarumoto
Department of Infectious Disease and Infection Control, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan; Corresponding author.
Kazuo Imai
Department of Infectious Disease and Infection Control, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
Hiroshi Yamaguchi
Department of Pathology, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
Masaaki Takeji
Department of Dermatology, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
Fumito Inayoshi
Department of Rheumatology and Applied Immunology, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
Keita Okamoto
Department of Rheumatology and Applied Immunology, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
Nobuhito Okumura
Department of Rheumatology and Applied Immunology, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
Shigefumi Maesaki
Department of Infectious Disease and Infection Control, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
Malignant syphilis (MS) is a rare variant of secondary syphilis. Also known as rupioid syphilis, MS is characterized by the presence of multiple papules, papulopustules, black lamellate crust that may resemble an oyster shell, or nodules with ulceration lacking central clearing. MS is often associated with immunodeficiency and frequently co-occurs with HIV infection. We here report a case of MS in a patient with HIV infection. HIV infection can cause atypical clinical symptoms of syphilis. In this case, unlike previous cases, cutaneous lesions of MS were limited to the face, making the diagnosis challenging based on clinical findings alone. However, his laboratory findings, appearance of the Jarisch-Herxheimer reaction, and a dramatic response to antibiotic therapy are characteristic of MS, making the diagnosis even more certain. Our case suggests the importance of physicians considering the possibility of MS when observing black-crusted lesions.
