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Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma
Malignant syphilis or lues maligna is a severe form of secondary syphilis that was commonly reported in the pre-antibiotic era, and has now reemerged with the advent of the human immunodeficiency virus (HIV) epidemic. However, the characteristic histopathological findings of malignant syphilis remai...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4599588/ https://www.ncbi.nlm.nih.gov/pubmed/26449225 http://dx.doi.org/10.1186/s13000-015-0419-5 |
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author | Yamashita, Michiko Fujii, Yoshiyuki Ozaki, Keiji Urano, Yoshio Iwasa, Masami Nakamura, Shingen Fujii, Shiro Abe, Masahiro Sato, Yasuharu Yoshino, Tadashi |
author_facet | Yamashita, Michiko Fujii, Yoshiyuki Ozaki, Keiji Urano, Yoshio Iwasa, Masami Nakamura, Shingen Fujii, Shiro Abe, Masahiro Sato, Yasuharu Yoshino, Tadashi |
author_sort | Yamashita, Michiko |
collection | PubMed |
description | Malignant syphilis or lues maligna is a severe form of secondary syphilis that was commonly reported in the pre-antibiotic era, and has now reemerged with the advent of the human immunodeficiency virus (HIV) epidemic. However, the characteristic histopathological findings of malignant syphilis remain controversial. The aim of this case report was to clarify the clinical and histopathological findings of HIV-positive malignant secondary syphilis. A Japanese man in his forties complained of fever, skin lesions, headache, and myalgia without lymphadenopathy during the previous 4 weeks. The skin lesions manifested as erythematous, nonhealing, ulcerated papules scattered on his trunk, extremities, palm, and face. Although the skin lesions were suspected to be cutaneous T-cell lymphomas on histological analyses, they lacked T-cell receptor Jγ rearrangement; moreover, immunohistochemical analyses confirmed the presence of spirochetes. The patient was administered antibiotics and anti-retroviral therapy, which dramatically improved the symptoms. On the basis of these observations of the skin lesions, we finally diagnosed the patient with HIV-associated secondary syphilis that mimicked cutaneous T-cell lymphoma. The patient’s systemic CD4+ lymphocyte count was very low, and the infiltrate was almost exclusively composed of CD8+ atypical lymphocytes; therefore, the condition was easily misdiagnosed as cutaneous lymphoma. Although the abundance of plasma cells is a good indicator of malignant syphilis on skin histological analyses, in some cases, the plasma cell count may be very low. Therefore, a diagnosis of malignant secondary syphilis should be considered before making a diagnosis of primary cutaneous peripheral T-cell lymphoma or lymphoma associated with HIV infection. |
format | Online Article Text |
id | pubmed-4599588 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-45995882015-10-10 Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma Yamashita, Michiko Fujii, Yoshiyuki Ozaki, Keiji Urano, Yoshio Iwasa, Masami Nakamura, Shingen Fujii, Shiro Abe, Masahiro Sato, Yasuharu Yoshino, Tadashi Diagn Pathol Case Report Malignant syphilis or lues maligna is a severe form of secondary syphilis that was commonly reported in the pre-antibiotic era, and has now reemerged with the advent of the human immunodeficiency virus (HIV) epidemic. However, the characteristic histopathological findings of malignant syphilis remain controversial. The aim of this case report was to clarify the clinical and histopathological findings of HIV-positive malignant secondary syphilis. A Japanese man in his forties complained of fever, skin lesions, headache, and myalgia without lymphadenopathy during the previous 4 weeks. The skin lesions manifested as erythematous, nonhealing, ulcerated papules scattered on his trunk, extremities, palm, and face. Although the skin lesions were suspected to be cutaneous T-cell lymphomas on histological analyses, they lacked T-cell receptor Jγ rearrangement; moreover, immunohistochemical analyses confirmed the presence of spirochetes. The patient was administered antibiotics and anti-retroviral therapy, which dramatically improved the symptoms. On the basis of these observations of the skin lesions, we finally diagnosed the patient with HIV-associated secondary syphilis that mimicked cutaneous T-cell lymphoma. The patient’s systemic CD4+ lymphocyte count was very low, and the infiltrate was almost exclusively composed of CD8+ atypical lymphocytes; therefore, the condition was easily misdiagnosed as cutaneous lymphoma. Although the abundance of plasma cells is a good indicator of malignant syphilis on skin histological analyses, in some cases, the plasma cell count may be very low. Therefore, a diagnosis of malignant secondary syphilis should be considered before making a diagnosis of primary cutaneous peripheral T-cell lymphoma or lymphoma associated with HIV infection. BioMed Central 2015-10-08 /pmc/articles/PMC4599588/ /pubmed/26449225 http://dx.doi.org/10.1186/s13000-015-0419-5 Text en © Yamashita et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Case Report Yamashita, Michiko Fujii, Yoshiyuki Ozaki, Keiji Urano, Yoshio Iwasa, Masami Nakamura, Shingen Fujii, Shiro Abe, Masahiro Sato, Yasuharu Yoshino, Tadashi Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma |
title | Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma |
title_full | Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma |
title_fullStr | Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma |
title_full_unstemmed | Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma |
title_short | Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma |
title_sort | human immunodeficiency virus-positive secondary syphilis mimicking cutaneous t-cell lymphoma |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4599588/ https://www.ncbi.nlm.nih.gov/pubmed/26449225 http://dx.doi.org/10.1186/s13000-015-0419-5 |
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