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Case Reports
. 2023 Sep 15;15(9):e45328.
doi: 10.7759/cureus.45328. eCollection 2023 Sep.

A Peculiar Presentation of Syphilis as a Mysterious Rash: A Dermatological Dilemma

Priscila Lopez  1 , Ifeoma Kwentoh  2   1 , Mario Valdez Imbert  1
Affiliations
Case Reports

A Peculiar Presentation of Syphilis as a Mysterious Rash: A Dermatological Dilemma

Priscila Lopez et al. Cureus. .

Abstract

A renowned poet in the ancient city of Verona by the name of Girolamo Fracastoro coined the term syphilis in 1530. The stigma and shame that embodied this affliction has been time immemorial and disabling for patients. The hypothesis of the spread from the warm tropics of west and central Africa to the Iberian Peninsula accompanied by the slave trade has been a tale for centuries. Malignant syphilis is a rare skin manifestation of Treponema pallidum infection and a variant of secondary syphilis. The rash is frequently associated with HIV-infected patients, often with low cluster differentiation 4 (CD4) cell count. The authors reported a unique case involving a 46-year-old woman who presented with a one-week history of skin eruptions at various stages. Subsequent laboratory tests revealed a strong positive result for Treponema pallidum and a positive Rapid Plasma Reagin (RPR) test with a titer of 1:16. She received doxycycline because she had a history of penicillin anaphylaxis in the past. She did well, with a remarkable improvement in symptoms - a positive outcome for this catastrophic stigmatizing, rare diagnosis.

Keywords: #cutaneous syphilis; #hiv aids; #hiv-hcv co-infection; #kaposi's sarcoma-associated herpesvirus (kshv); #monkey pox virus rash; #sexually transmitted infection (sti).

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The patient had a generalized, nontender maculopapular rash characterized by erythematous papule-plaques, some with a necrotic center, ulcers covered with dark crusts, and the presence of blisters.
Figure 2
Figure 2. T-cell subset data.
ABS CD3, absolute cluster of differentiation cells 3; ABSO CD4, absolute cluster of differentiation cells 4
Figure 3
Figure 3. (Top panel) Before treatment; (bottom panel) dramatic improvement of lesions after treatment.
See this image and copyright information in PMC

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