An abdominal skin lesion: to lump or split? a case presentation.

Area of Science:

• Infectious Diseases
• Dermatology
• Immunology

Background:

• Syphilis diagnosis can be challenging due to diverse atypical presentations.
• Patients with Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) are susceptible to multiple concurrent infections.
• Co-infections can alter the typical clinical manifestations of syphilis.

Observation:

• A 41-year-old male with newly diagnosed HIV presented with acute vision loss and a rash.
• He had concurrent diagnoses of secondary syphilis and Kaposi sarcoma in the context of AIDS.
• An unusual necrotic, umbilicated papule on the abdomen presented a diagnostic dilemma.

Findings:

• Skin biopsy confirmed secondary syphilis, despite the presence of Kaposi sarcoma.
• The patient's symptoms resolved following antibiotic and antiretroviral therapy.

Implications:

• This case underscores the importance of considering atypical syphilis presentations in immunocompromised patients.
• Awareness of diverse cutaneous manifestations is crucial for accurate diagnosis in co-infected individuals.
• Integrated management of syphilis and HIV/AIDS is essential for successful treatment outcomes.