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[Cutaneous manifestation of late-type syphilis].

AbstractHISTORY AND CLINICAL FINDINGS:
A 49-year-old, otherwise healthy man presented at his dermatologist with tuberous skin changes that had be present for several weeks on head, arm and leg. These were asymptomatic, but disturbed him cosmetically. A skin biopsy was performed.
INVESTIGATIONS:
The skin biopsy showed a granulomatous inflammation with prominent plasma cells, consistent with granulomatous infiltrate. Serologic tests confirmed a Treponema pallidum-infection. In addition, the patient was tested positive for hepatitis C and HIV (CDC stage A1). The clinical neurological examination did not show any pathological findings, however, analysis of the cerebrospinal fluid revealed a mild pleocytosis, elevation of protein and the glucose quotient and a normal Treponema pallidum TPPA-antibody index. A mesaortitis was excluded.
THERAPY AND COURSE:
We diagnosed a tertiary syphilis (stage III). The patient refused prolonged inpatient treatment with penicillin G i.v., as recommended as first-line therapy in the national guidelines for asymptomatic neurosyphilis. Therefore, after a single oral administration of 100 mg prednisolone he received ceftriaxone intravenously for 14 days. The skin changes resolved. With regard to the HIV infection anti-retro-viral therapy was not yet indicated.
CONCLUSIONS:
In view of the increasing incidence of syphilis in Germany clinicians should consider this diagnosis when confronted with oligosymptomatic skin lesions.
AuthorsC Schummer, S Schliemann, V Fünfstück, P Elsner
JournalDeutsche medizinische Wochenschrift (1946) (Dtsch Med Wochenschr) Vol. 139 Issue 38 Pg. 1883-6 (Sep 2014) ISSN: 1439-4413 [Electronic] Germany
Vernacular TitleHautmanifestation bei Spätsyphilis.
PMID25203547 (Publication Type: Case Reports, English Abstract, Journal Article)
Copyright© Georg Thieme Verlag KG Stuttgart · New York.
Chemical References
  • Ceftriaxone
  • Prednisolone
Topics
  • Administration, Oral
  • Biopsy
  • Ceftriaxone (administration & dosage)
  • Comorbidity
  • Diagnosis, Differential
  • Drug Therapy, Combination
  • HIV Seropositivity (diagnosis, pathology)
  • Hepatitis C, Chronic (diagnosis, pathology)
  • Humans
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Neurosyphilis (diagnosis, drug therapy, pathology)
  • Prednisolone (administration & dosage)
  • Skin (pathology)
  • Syphilis (diagnosis, drug therapy, pathology)
  • Syphilis Serodiagnosis
  • Syphilis, Cutaneous (diagnosis, drug therapy, pathology)

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