Malignant syphilis requiring differentiation from Kaposi's sarcoma

Area of Science:

• Dermatology
• Infectious Diseases
• Syphilology

Background:

• Malignant syphilis (MS), also known as rupioid syphilis, is an uncommon manifestation of secondary syphilis.
• MS typically presents with ulcerated, crusted lesions and is frequently associated with immunodeficiency, particularly HIV infection.

Purpose of the Study:

• To report a case of malignant syphilis in an HIV-infected patient.
• To highlight the diagnostic challenges posed by atypical clinical presentations of MS.
• To underscore the importance of considering MS in patients with characteristic crusting lesions.

Main Methods:

• Case report of a patient with HIV infection presenting with atypical cutaneous lesions.
• Clinical evaluation of skin manifestations.
• Laboratory confirmation of syphilis.
• Observation of the Jarisch-Herxheimer reaction and response to antibiotic therapy.

Main Results:

• The patient presented with malignant syphilis, characterized by black, lamellate crusting lesions predominantly on the face.
• Clinical presentation was atypical, with lesions limited to the face, complicating initial diagnosis.
• Laboratory findings, the Jarisch-Herxheimer reaction, and a positive response to antibiotics confirmed the diagnosis of MS.

Conclusions:

• HIV infection can lead to atypical clinical presentations of malignant syphilis.
• Physicians should consider malignant syphilis in the differential diagnosis of patients presenting with black-crusted lesions, even with limited or atypical lesion distribution.
• Early diagnosis and appropriate antibiotic treatment are crucial for managing malignant syphilis.