A case of secondary syphilis mimicking palmoplantar psoriasis in HIV infected patient

Abstract

Due to diverse clinical and histopathological presentations, diagnosis of secondary syphilis can occasionally prove challenging. Variable clinical presentations of secondary syphilis in HIV disease may result in an incorrect diagnosis and an inappropriate treatment regimen. Similarly, the histology of secondary syphilitic lesions may show considerable variation, depending on the clinical morphology of the eruption. We report a case of secondary syphilis in an HIV infected patient with cutaneous palmoplantar lesions simulating palmoplantar psoriasis.

FIGURE 1

A. Erythematous-scaly plaque on soles. B. Erythematous-scaly plaque on palms

FIGURE 2

A. Periungual erythema and edema, subungueal hyperkeratosis and onychodystrophy of toenails. B. infiltrated erythematous-scaly plate, circinated, on the sole and dorsal part of right foot

FIGURE 3

A. Psoriasiform hyperplasia and lichenoid infiltrate which darkens the dermal-epidermal interface, a mix of lymphocytes, histiocytes, plasmocytes and neutrophils (H&E, x10). B. Compact hyperkeratosis, parakeratosis and intracorneal neutrophils (H&E, x10). C. Lymphohistiocytic interstitial infi ltrate, superficial and deep (H&E, x40). D. Inflammatory infiltrate involving deep annexes (H&E, x40)

FIGURE 4

A and B. Clinical aspect of palmoplantar lesions 1 week after completion of treatment with benzathine penicillin

FIGURE 5

A and B. Clinical aspect of ungual lesions 1 week after completion of treatment with benzathine penicillin