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A Peculiar Pattern: Nodular Secondary Syphilis with Granulomatous Dermatitis
Marian Rosel D Villaverde1, Juan Paolo David S Villena1, Claudine Yap Silva1
1Department of Dermatology, Philippine General Hospital, University of the Philippines Manila.
Acta Medica Philippina
|October 21, 2024
Summary
Nodular syphilis, an uncommon skin manifestation of secondary syphilis, presents a diagnostic challenge due to its granulomatous pattern. Early recognition and treatment are crucial, especially in HIV patients.
Area of Science:
- Dermatology
- Infectious Diseases
- Pathology
Background:
- Secondary syphilis can present with diverse cutaneous manifestations.
- Nodular syphilis with a granulomatous histopathologic pattern is rare and diagnostically challenging.
Observation:
- A 33-year-old HIV-positive male presented with asymptomatic, generalized erythematous papules and nodules, including palms and soles.
- Histopathology revealed non-caseating granulomas with a mixed inflammatory infiltrate and positive Warthin-Starry stain for spirochetes.
Findings:
- The case highlights nodular syphilis with an unusual granulomatous pattern.
- Rapid plasma reagin (RPR) was reactive at 1:256.
- Treatment with benzathine penicillin G resulted in complete resolution of lesions and decreased RPR titers.
Implications:
- Clinicians and pathologists must consider nodular syphilis in the differential diagnosis of granulomatous skin lesions.
- Increased awareness is vital given the rising prevalence of syphilis, particularly in HIV-infected individuals.
- Prompt diagnosis and treatment are essential for favorable outcomes.
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