A case of cutaneous tertiary syphilis: a great masquerader
The present case has been published in the Annals of Dermatology.

A 48-year-old woman presented with a painless ulcerated plaque on her face for 2 months. At another hospital, she had been treated with antibiotic and antiviral therapies with repetitive dressings, which was not successful. She was previously healthy and denied trauma and skin cancer history.

Physical examination showed a 4×4 cm crater-shaped plaque with crusts and oozing. Provisional diagnosis included pyoderma gangrenosum and squamous cell carcinoma. Skin biopsy demonstrated extensive necrosis and large areas of granulomatous inflammation within the dermis, including numerous multinucleated giant cells and marked lymphoplasmacytic infiltrates.

A rapid plasma regain test was reactive (1:16), and fluorescent treponemal antibody-absorption (FTA-ABS) tests for immunoglobulin M (IgM) and immunoglobulin G were both positive. A human immunodeficiency virus (HIV) test was negative. Only then did the patient mention that she was inadequately treated for syphilis 20 years ago.

Taken together, she was finally diagnosed with a syphilitic gumma. Further work up including cerebrospinal fluid analysis did not reveal any evidence of internal organ involvement. The lesion was significantly improved after three intramuscular injections of 2.4 million units of penicillin G.

Learning Points:-
- Almost one-third of patients with primary or secondary syphilis who were untreated can develop the late manifestations such as cutaneous syphilis, neurosyphilis, or cardiovascular syphilis.

- Cutaneous tertiary syphilis accounts for about 16% of them. The time to progress to tertiary syphilis varies from several months to 35 years after infection.

- As cutaneous tertiary syphilis clinically simulates many other skin diseases, its diagnosis should depend on a comprehensive interpretation of the patient's medical history, pathologic findings, and serology results.

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Dr. S●●●●●●m H●●●●●●r
Dr. S●●●●●●m H●●●●●●r General Medicine
Of late STD have come down drastically. As a result such findings as in this case do not give a clue about syphilitic lesions. It is only after short listing conclusion is drawn. In this case probably she was re-exposed to Syphilis.
Dec 15, 2018Like