P1246990957LvnHC - PowerPoint PPT Presentation
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Title: P1246990957LvnHC
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An old enemy strikes back Malignant syphilis
German Luy, MD, Cathy Logan, MD, Gustavo
Heudebert, MD The University of Alabama at
Birmingham - Birmingham, Alabama
Diagnostic Studies
Background
- Syphilis can have atypical presentations in
HIV patients - There is a current outbreak of syphilis in
Jefferson - county, AL
- Positive RPR ( 164) and FTA abs
- Skin Bx Mixed dermal inflammatory infiltrate
with presence of spirochetes - on an immunoperoxidase stain .Special stains
for fungi (PAS) and - mycobacteria (AFB) were negative
Learning Objectives
- To recognize the clinical presentation of
malignant - syphilis
Malignant Syphilis
History and PE
- Malignant syphilis is an infrequent form of
secondary syphilis - characterized by a prodrome of fever,
myalgias and headache followed - by a papulo-pustular eruption that rapidly
transforms into necrotic and - sharply marginated ulcers with hemorrhagic
brown crusts. (1) - Malignant syphilis in 60 times more frequent in
HIV patients compared - to the general population . (2)
- It's also associated with malnutrition , IVDU
and alcoholism. - Most of the reported cases associated with HIV
had a CD4 count 200 - cells and an ocular compromise occurred in
1/3 of the patients. (3) - The differential diagnosis in HIV patients
with necrotic and pustular
- HPI
- A 35 yo caucasian female presented with a 2
week history of a diffuse pruritic and painful
rash , associated with malaise,myalgias and
fevers up to 102. - PMHx
- HIV since 1996, No HAART Tx
- No prior OIs . CD4 11 in 2005
- No current medications
- Cocaine abuse . Reportedly monogamous .
- PE T 101.8 , HR90 x , 110/70
- Thin white female in NAD
- The skin exam showed a diffuse symmetric
- polymorphic rash in her face ,trunk and
- extremities including palms and soles ,
characterized - by discrete erythematous
papular-pustular lesions, - some with crusted necrotic centers,
ranging in size - from 5 to 25 mm
- Her oral exam showed three small ulcers in
the hard - palate
References
- Kumar B, Muralidhar S .Malignant syphilis A
Review. AIDS Patient Care and STDs 1998.
Volume 12 . 921-25 - Schofer H, Imhof M, Thoma-Greber E et al. Active
syphilis in HIV infection a multicentre
retrospective survey. The German AIDS Study Group
(GASG). Genitourin Med 1996 72 176-81. - Romero-Jimenez M.J , Suarez-Lozano I,
Fajardo-Pico J.M et al. Malignant syphilis in
patient with Human Immunodeficiency Virus (HIV)
Case report and literature review. AN. MED.
INTERNA (Madrid) 2003 . Vol. 20, N.º 7 373-76 - Don Pc, Rubinstein R, Christie R. Malignant
syphillis an concurrent infection with HIV. Int J
Dermatol 199534 403-407 - Wappner D,Carbia S, Gioseffi L et al. Diagnosis
Malignant syphilis. Clin Infect Dis
1997251343,1447 - Tosca A, Stravopoulos PG, Hatziolou E et al.
Malignant syphilis is HIV infected patients. Int
J Dermatol 1990,29 575-578
References
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Take Home Point
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