Abstract
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 4weeks. 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 J 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.
| Original language | English |
|---|---|
| Article number | 185 |
| Journal | Diagnostic Pathology |
| Volume | 10 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Oct 8 2015 |
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Keywords
- CD8
- Co-infection
- Cutaneous T-cell lymphoma
- HIV-1
- Human immunodeficiency virus (HIV)
- Lues maligna
- Malignant secondary syphilis
- Skin lesions
- Syphilis
ASJC Scopus subject areas
- Histology
- Pathology and Forensic Medicine
Cite this
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.
In: Diagnostic Pathology, Vol. 10, No. 1, 185, 08.10.2015.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma
AU - Yamashita, Michiko
AU - Fujii, Yoshiyuki
AU - Ozaki, Keiji
AU - Urano, Yoshio
AU - Iwasa, Masami
AU - Nakamura, Shingen
AU - Fujii, Shiro
AU - Abe, Masahiro
AU - Sato, Yasuharu
AU - Yoshino, Tadashi
PY - 2015/10/8
Y1 - 2015/10/8
N2 - 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 4weeks. 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 J 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.
AB - 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 4weeks. 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 J 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.
KW - CD8
KW - Co-infection
KW - Cutaneous T-cell lymphoma
KW - HIV-1
KW - Human immunodeficiency virus (HIV)
KW - Lues maligna
KW - Malignant secondary syphilis
KW - Skin lesions
KW - Syphilis
UR - http://www.scopus.com/inward/record.url?scp=84943540407&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84943540407&partnerID=8YFLogxK
U2 - 10.1186/s13000-015-0419-5
DO - 10.1186/s13000-015-0419-5
M3 - Article
C2 - 26449225
AN - SCOPUS:84943540407
VL - 10
JO - Diagnostic Pathology
JF - Diagnostic Pathology
SN - 1746-1596
IS - 1
M1 - 185
ER -