Secondary syphilis mimicking cutaneous lymphoma.

Area of Science:

• Dermatology
• Infectious Diseases
• Pathology

Background:

• Secondary syphilis presents with diverse clinical manifestations.
• Human immunodeficiency virus (HIV) infection can alter the presentation of syphilis.
• Distinguishing syphilis from other conditions like cutaneous lymphoma is crucial for effective treatment.

Observation:

• A 30-year-old male with HIV presented with fever, cough, and widespread papular lesions.
• Serological tests (VDRL, TPHA) were positive for syphilis.
• Skin biopsy findings were suggestive of cutaneous lymphoma, creating a diagnostic challenge.

Findings:

• Despite concerning histopathology, the patient's clinical presentation and positive serology strongly indicated secondary syphilis.
• Treatment with penicillin resulted in a favorable clinical response.
• The patient was later initiated on antiretroviral therapy for HIV.

Implications:

• This case underscores the diagnostic complexities of secondary syphilis in HIV-coinfected individuals.
• It emphasizes the need for integrated clinical, serological, and histopathological assessment.
• Early and accurate diagnosis of syphilis in HIV patients is vital to prevent complications and ensure appropriate management.