Nodular Syphilis Seen in an HIV-Positive Man: A Case Study

Area of Science:

• Infectious Diseases
• Dermatology
• Public Health

Background:

• Syphilis cases are rising in the USA, particularly among young adults, posing a concern in primary care and military medicine.
• Nodular syphilis is a rare secondary manifestation, with limited data on effective treatment compared to typical maculopapular rashes.

Purpose of the Study:

• To report a case of nodular secondary syphilis in an HIV-positive individual.
• To highlight an effective treatment regimen for this rare presentation.
• To increase awareness among clinicians regarding nodular syphilis.

Main Methods:

• A case study of a 54-year-old HIV-positive male presenting with nodular skin lesions.
• Differential diagnosis included erythema nodosum, arthropod vector disease, and other dermatological conditions.
• Diagnosis confirmed via skin biopsy showing granulomatous dermatitis and positive serology for Treponema pallidum.

Main Results:

• The patient was diagnosed with secondary syphilis with granulomatous dermatitis.
• An empiric 2-week course of oral doxycycline effectively treated the nodular lesions.
• Rapid plasma reagin (RPR) titer was 1:256, indicating active infection.

Conclusions:

• Clinicians should consider nodular secondary syphilis in the differential diagnosis of patients with nodular skin lesions.
• Oral doxycycline can be an effective treatment for nodular syphilis.
• Early recognition and treatment are crucial, especially in high-risk individuals.