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Case Reports
. 2018 Mar 28:6:2050313X18767229.
doi: 10.1177/2050313X18767229. eCollection 2018.

Non-primary nail-plate syphilis in an HIV-infected patient

Chiara Gabrielli  1 , Salvatore Cardaci  1 , Lisa Malincarne  1 , Maria Bruna Pasticci  1
Affiliations
Case Reports

Non-primary nail-plate syphilis in an HIV-infected patient

Chiara Gabrielli et al. SAGE Open Med Case Rep. .

Abstract

A 37-year-old Caucasian male, HIV-infected (CDC A2) in 2012 and on antiretroviral therapy, presented for a follow-up visit. On physical examination, a barely discernible light-colored macular rash was observed on the trunk, not involving the palms and soles. However, clear maculo-papular lesions were present over the proximal volar aspect of both forearms. Furthermore, well-demarked purplish, opaque, rough, vertically ridged plaque-like lesions were observed over the proximal portions of fingernails. The patient reported that cutaneous and nail lesions had appeared about 2 months prior and that he had engaged in unprotected sex 5 months before. Serologic tests for syphilis resulted reactive. Intramuscular injection of benzathine penicillin G, 2.4 million units, was administered once a week for 3 weeks. One month after therapy, the rash was no longer present, and at 5 months, nail abnormalities had disappeared. The clinical findings, the serologic results, and the disappearance of skin and nail lesions after the administration of penicillin strongly suggest that this HIV-infected patient had secondary or early late syphilis with skin and nail-plate involvement. We are experiencing a resurgence of syphilis as well as an increase in unusual and/or forgotten clinical manifestations. Syphilis remains a diagnostically challenging disease.

Keywords: HIV infection; Syphilis; early latent; nail syphilis; syphilis secondary.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
(a, b) Maculo-papular rash on volar aspect of both forearms; (c) purplish, opaque, rough, vertically ridged, plaque-like lesions on the left hand index finger; and (d) same lesion type on the right hand little finger.
Figure 2.
Figure 2.
Following the administration of penicillin: (a) resolution of nail lesions and (b) linear scar on the right little finger.
See this image and copyright information in PMC

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