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Two recent cases of tertiary syphilis.

P Varela1, R Alves, G Velho

  • 1Dermatology and Venereology Departement, Hospital Geral de S. António, Porto, Portugal. varela@esoterica.pt

European Journal of Dermatology : EJD
|August 28, 1999
PubMed
Summary

Tertiary syphilis, though rare, requires high suspicion for diagnosis due to misleading symptoms and low serological titers. Early syphilis is rising, making awareness crucial for accurate diagnosis and treatment.

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Area of Science:

  • Infectious Diseases
  • Dermatology
  • Epidemiology

Background:

  • Tertiary syphilis incidence is declining in Europe but rising in the USA and Germany.
  • Maintaining high clinical suspicion is essential for diagnosing tertiary syphilis.
  • Early and late syphilis require distinct diagnostic considerations.

Observation:

  • Two cases of benign tertiary syphilis presented with atypical skin lesions.
  • One patient had annular scaling plaques, the other had erythematous plaques and facial ulcers.
  • Both patients exhibited negative or low VDRL (Venereal Disease Research Laboratory) titers.

Findings:

  • Skin biopsies showed plasmacytic infiltrate and endothelial swelling, without granulomas or positive silver stains.
  • Cardiovascular and neurological involvement were ruled out in both cases.

Related Experiment Videos

  • Diagnosis of tertiary syphilis can be challenging due to varied presentations and non-reactive serology.

    • Implications:

    • These cases highlight the importance of considering syphilis in differential diagnoses, even with negative serology.
    • Prompt recognition and exclusion of neurosyphilis and cardiovascular syphilis are critical.
    • Increased awareness can prevent misdiagnosis and ensure appropriate treatment for tertiary syphilis.