Version 1
: Received: 25 April 2024 / Approved: 26 April 2024 / Online: 26 April 2024 (19:34:48 CEST)
How to cite:
Jimenez, D.; Rabe, M.S.; Agarwal, A.N.; Dalton, S.R.; Anstead, G.M. An Exuberant Case of Ulceronodular-Rupioid (Malignant) Syphilis in an HIV Patient. A Proposal for New Diagnostic Criteria. Preprints2024, 2024041779. https://doi.org/10.20944/preprints202404.1779.v1
Jimenez, D.; Rabe, M.S.; Agarwal, A.N.; Dalton, S.R.; Anstead, G.M. An Exuberant Case of Ulceronodular-Rupioid (Malignant) Syphilis in an HIV Patient. A Proposal for New Diagnostic Criteria. Preprints 2024, 2024041779. https://doi.org/10.20944/preprints202404.1779.v1
Jimenez, D.; Rabe, M.S.; Agarwal, A.N.; Dalton, S.R.; Anstead, G.M. An Exuberant Case of Ulceronodular-Rupioid (Malignant) Syphilis in an HIV Patient. A Proposal for New Diagnostic Criteria. Preprints2024, 2024041779. https://doi.org/10.20944/preprints202404.1779.v1
APA Style
Jimenez, D., Rabe, M.S., Agarwal, A.N., Dalton, S.R., & Anstead, G.M. (2024). An Exuberant Case of Ulceronodular-Rupioid (Malignant) Syphilis in an HIV Patient. A Proposal for New Diagnostic Criteria. Preprints. https://doi.org/10.20944/preprints202404.1779.v1
Chicago/Turabian Style
Jimenez, D., Scott R. Dalton and Gregory M Anstead. 2024 "An Exuberant Case of Ulceronodular-Rupioid (Malignant) Syphilis in an HIV Patient. A Proposal for New Diagnostic Criteria" Preprints. https://doi.org/10.20944/preprints202404.1779.v1
Abstract
We report the case of a 28-year-old male with uncontrolled human immunodeficiency virus (HIV) infection who presented with extensive ulcerated lesions with dark lamellated crusting on his face, torso, and limbs. The patient had an RPR of 1:512. A skin biopsy revealed granulomata surrounded by lymphocytes, histiocytes, and plasma cells, with spirochetes visible on immunohistochemical staining. This severe form of secondary syphilis has been termed malignant syphilis, lues maligna, ulceronodular syphilis, and rupioid syphilis, among other names. The patient’s rash resolved with hyperpigmented scarring after treatment with penicillin and doxycycline. First, we propose a single descriptive name for this entity, ulceronodular-rupioid syphilis. In 1967, Fisher and coworkers proposed criteria for malignant syphilis based on lesion appearance, RPR values, histopathologic findings, the occurrence of the Jarisch-Herxheimer reaction, and response to treatment. However, the Fisher criteria were found to be imprecise. Thus, we examined the features of an additional 74 cases from the medical literature and propose new diagnostic criteria based on rash appearance, histopathologic characteristics, non-treponemal and treponemal test positivity, and response to therapy. We also found that uncontrolled viremia and not a low CD4 count is a major risk factor for this severe manifestation of secondary syphilis in the HIV population.
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
