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Summary
Late cutaneous syphilis can manifest years after initial treatment, presenting as nodular lesions or gummas. Specific serologic tests like FTA-ABS are crucial for diagnosis, even with negative VDRL and TPI results, confirming syphilis response to penicillin.
Area of Science:
- Dermatology
- Infectious Diseases
- Clinical Medicine
Background:
- Late benign syphilis, a tertiary stage of infection, can present with diverse mucocutaneous manifestations.
- Understanding its presentation is crucial for timely diagnosis and effective treatment, especially in cases with ambiguous serologic profiles.
Observation:
- Two patients with a history of treated secondary syphilis developed distinct late cutaneous manifestations: nodular syphilid and gummas.
- One patient exhibited nonreactive VDRL and negative TPI tests, but reactive FTA-ABS tests, highlighting the complexity of serologic diagnosis in late syphilis.
Findings:
- Histological examination, characteristic clinical presentation, and prompt response to penicillin confirmed syphilis in both cases.
- The fluorescent treponemal antibody absorption (FTA-ABS) test proved valuable in diagnosing late syphilis when other serologic markers were inconclusive.
Implications:
- These cases underscore the importance of considering late cutaneous syphilis in the differential diagnosis, even with prior treatment and conflicting serologic results.
- The findings emphasize the diagnostic utility of FTA-ABS testing and the efficacy of penicillin in treating late benign syphilis of the skin.