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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
|July 27, 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 tertiary syphilis diagnosis and treatment.

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Area of Science:

  • Infectious Diseases
  • Dermatology
  • Public Health

Background:

  • Tertiary syphilis incidence is declining in Europe but rising in the US and Germany.
  • Maintaining a high index of suspicion is crucial for diagnosing tertiary syphilis.
  • Early diagnosis and treatment of syphilis are essential to prevent progression to tertiary stages.

Observation:

  • Two cases of benign tertiary syphilis are presented, featuring varied skin lesions.
  • Patient 1: 55-year-old female with annular scaling plaques and low VDRL titer.
  • Patient 2: 33-year-old female with erythematous plaques, psoriasiform scaling, and facial ulcers, with negative VDRL.

Findings:

  • Skin biopsies showed plasmacytic infiltrate and endothelial swelling, without granulomas or positive silver stains.

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  • Serological tests (VDRL) were negative or low in both patients, complicating diagnosis.
  • Cardiovascular and neurological involvement were ruled out in both reported cases.

    • Implications:

    • Tertiary syphilis diagnosis can be challenging due to atypical presentations and low serological titers.
    • It is imperative to rule out neurological and cardiovascular involvement in suspected tertiary syphilis.
    • These cases highlight the importance of considering syphilis in differential diagnoses to prevent misdiagnosis and mistreatment.