Lues maligna in an immunocompetent male

Main Article Content

Carly Dunn http://orcid.org/0000-0002-0458-4897
Danielle S. Applebaum

Keywords

lues maligna, immunocompetent, syphilis, secondary syphilis

Abstract

Lues maligna (malignant syphilis) is an aggressive, rapidly developing, rare variant of secondary syphilis and is characterized by flu-like prodromal symptoms followed by an eruption of irregularly scattered erythematous papules and pustules that quickly progress into well-defined necrotic ulcers. Atypical presentations of syphilis, such as lues maligna, occur more commonly in HIV-positive and immunocompromised individuals. We present a rarer case of an immunocompetent patient with lues maligna. As syphilis is a great mimicker and is easily treatable, dermatologists should consider this diagnosis in a patient presenting with lesions consistent with pityriasis lichenoides et varioliformis acuta, drug eruption, disseminated herpes or zoster infection, cutaneous T-cell lymphoma, and ulcerating vasculitis.

References

Watson KMT, White JML, Salisbury JR, Creamer D. Lues maligna. Clin Exp Dermatol. 2004;29(6):625-627. doi:10.1111/j.1365-2230.2004.01630.x.

Chang WT, Hsieh TT, Wu YH. Malignant syphilis in human immunodeficiency virus-infected patients. Derm Sinica. 2015;33:21-25.

Pföhler C, Koerner R, Von Müller L, Vogt T, Müller CSL. Lues maligna in a patient with unknown HIV infection. BMJ Case Rep. 2011;2011:bcr0520114221. doi:10.1136/bcr.05.2011.4221.

Stevenson J, Heath M. Syphilis and HIV infection: an update. Dermatol Clin. 2006;24:497-507.

Schöfer H, Imhof M, Thoma-Greber E, et al. Active syphilis in HIV infection: a multicentre retrospective survey. Genitourin Med. 1996;72:176-81.

Romero-Jimenez MJ, Suarez Lozano I, Fajardo Pico JM, Baron Franco B. Malignant syphilis in patient with human immunodeficiency virus (HIV): case report and literature review. An Med Interna. 2003;20(7):373–6 [in Spanish].

Maldonado P, Sendagorta Cudos E, Zamora Vargas FX, Merino MJ, Pinto PH. Pathologically confirmed malignant syphilis using immunohistochemical staining: report of 3 cases and review of literature. Sex Transm Dis. 2014;41:94-97.

Witkowski JA, Parish LC. The great imitator: malignant syphilis with hepatitis. Clin Dermatol. 2002;20(2):156-163. doi:10.1016/S0738-081X(01)00249-8.

Yamashita M, Fujii Y, Ozaki K, et al. Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma. Diagn Pathol. 2015;10(1). doi:10.1186/s13000-015-0419-5.

Stary, A, Stary, G. Sexually Transmitted Infections. Dermatology, by Jean L. Bolognia et al., Elsevier, 2018, pp. 1447–1469.

Sands M, Markus A. Lues maligna, or ulceronodular syphilis, in a man infected with human immunodeficiency virus: case report and review. Clin Infect Dis. 1995;20:387-390.

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