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After treatment with potassium penicillin G, the skin lesions resolved completely (A, B) and the optic disc was clearly seen in fundoscopic findings (C).
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Syphilitic keratoderma is a rare cutaneous manifestation of secondary syphilis, characterized by symmetrical and diffuse hyperkeratosis of the palms and soles. In addition, no cases of syphilitic keratoderma and uveitis have been reported in the dermatologic literature. A 69-year-old woman presented with steroid-resistant hyperkeratotic patches on...
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Context 1
... 69-year-old woman presented for evaluation of hyper- keratotic scaly patches on her palms and soles. She also complained of progressive visual disturbance. Four months ago, asymptomatic scaly patches had developed on her palms and soles. Despite treatment with topical and systemic steroids for 4 months, the skin lesions were not improved. Two months ago, she developed visual blurring, and her visual acuity was not improved with sys- temic steroid and ophthalmic steroid suspension. Physical examination revealed symmetric erythematous hyper- keratotic scaly patches on palms and soles (Fig. 1A, B). KOH mount from the hyperkeratotic lesion was negative. Fundoscopic findings showed that optic disc was ob- scured by a dense vitreous haze, which suggested uveitis (Fig. 1C). She had divorced twenty years ago and could not recall her exact sexual contact history. As steroid-re- sistant uveitis must be evaluated for syphilis, viral in- fections, and autoimmune diseases, we ran VDRL, HIV antibody, HSV IgM, Toxoplasma IgG/IgM, CMV IgG/IgM, and rheumatic factor tests. The VDRL titer was 1:128, and the FTA-ABS IgG/M test and TPHA were positive. Other laboratory findings were within normal limits. Skin biopsy was performed on the palm. Histological findings showed hyperkeratosis, para- keratosis, and dermal lichenoid infiltration with lympho- cytes and sparse plasma cells (Fig. 2). Her CSF was also examined, because ocular syphilis tends to be associated with neurosyphilis. CSF study showed reactive FTA-ABS and lymphocytic pleocytosis. Upon diagnosis of syphilitic keratoderma with uveitis and asymptomatic neurosyphilis, she was treated with potassium penicillin G, 4 MU, IV ev- ery 4 hours for 2 weeks. After 2 weeks, her skin lesions and visual disturbance were completely resolved (Fig. 3A, B) and fundoscopic findings clearly showed the optic disc (Fig. 3C). There was no recurrence of skin lesions and the VDRL test titer decreased to 1:64 after 4 months of follow up. Histopathological examination of the hypopigmented patch revealed hyperkeratosis, acanthosis in the epi- dermis, and perivascular inflammatory cells infiltration in the upper dermis ( Fig. 2A). The dermal infiltrate consisted of lymphohistiocytes and sparse plasma cells (Fig. 2B). Although the patient was treated with topical steroid twice a day for 1 month, no regression of the lesions was ...
Context 2
... 69-year-old woman presented for evaluation of hyper- keratotic scaly patches on her palms and soles. She also complained of progressive visual disturbance. Four months ago, asymptomatic scaly patches had developed on her palms and soles. Despite treatment with topical and systemic steroids for 4 months, the skin lesions were not improved. Two months ago, she developed visual blurring, and her visual acuity was not improved with sys- temic steroid and ophthalmic steroid suspension. Physical examination revealed symmetric erythematous hyper- keratotic scaly patches on palms and soles (Fig. 1A, B). KOH mount from the hyperkeratotic lesion was negative. Fundoscopic findings showed that optic disc was ob- scured by a dense vitreous haze, which suggested uveitis (Fig. 1C). She had divorced twenty years ago and could not recall her exact sexual contact history. As steroid-re- sistant uveitis must be evaluated for syphilis, viral in- fections, and autoimmune diseases, we ran VDRL, HIV antibody, HSV IgM, Toxoplasma IgG/IgM, CMV IgG/IgM, and rheumatic factor tests. The VDRL titer was 1:128, and the FTA-ABS IgG/M test and TPHA were positive. Other laboratory findings were within normal limits. Skin biopsy was performed on the palm. Histological findings showed hyperkeratosis, para- keratosis, and dermal lichenoid infiltration with lympho- cytes and sparse plasma cells (Fig. 2). Her CSF was also examined, because ocular syphilis tends to be associated with neurosyphilis. CSF study showed reactive FTA-ABS and lymphocytic pleocytosis. Upon diagnosis of syphilitic keratoderma with uveitis and asymptomatic neurosyphilis, she was treated with potassium penicillin G, 4 MU, IV ev- ery 4 hours for 2 weeks. After 2 weeks, her skin lesions and visual disturbance were completely resolved (Fig. 3A, B) and fundoscopic findings clearly showed the optic disc (Fig. 3C). There was no recurrence of skin lesions and the VDRL test titer decreased to 1:64 after 4 months of follow up. Histopathological examination of the hypopigmented patch revealed hyperkeratosis, acanthosis in the epi- dermis, and perivascular inflammatory cells infiltration in the upper dermis ( Fig. 2A). The dermal infiltrate consisted of lymphohistiocytes and sparse plasma cells (Fig. 2B). Although the patient was treated with topical steroid twice a day for 1 month, no regression of the lesions was ...
Citations
... Plantar hyperkeratosis is the hallmark of syphilitic keratoderma. This form has rarely been described in the literature, and clinically it is indistinguishable from other common dermatoses on volar aspects, such as keratoderma blenorrhagicum, hyperkeratotic eczema, and keratoderma associated with Unna-Thost syndrome or Howel-Evans syndrome [6]. Psoriasiform syphilis is another atypical presentation of secondary syphilis that imitates psoriasis, and clinicians should be aware of this presentation to avoid the prescription of erroneous therapies [7]. ...
Syphilis is a re-emerging disease, and an increasing number of cases are being reported in Italy and worldwide. In this report, we present a case of a male patient with secondary syphilis characterized by the heterogenicity of the lesions: hyperkeratosis, psoriasiform-like lesions, papules, macules, and patchy alopecia on the scalp. The patient had applied several topical antimicrobials and steroid medicaments and taken oral acyclovir, which yielded no relief, for a previous wrong diagnosis. At the time of his presentation to our clinic, syphilis was suspected and confirmed by serology. The administration of a single intramuscular dose of penicillin led to a full recovery in three weeks. Screening for HIV and other sexually transmitted infections returned negative. Clinicians should maintain a high index of suspicion for syphilis when encountering sexually active patients with atypical skin manifestations.
... 3 There have also been reported associations with lupus erythematosus, myasthenia gravis, syphilis, and tuberculosis. [4][5][6] In these cases, the PPK cleared with treatment of the underlying ailment, suggesting a reactive pathophysiology similar to that seen in reactive arthritis and keratoderma blennorrhagicum. 1 Genetic and environmental factors and the loss of immune tolerance all play roles in the development of PBC; however, PBC treatment is primarily aimed at stabilizing the bile ducts rather than reducing systemic inflammation. UDCA expands the bile acid pool by exerting direct choleretic, antiinflammatory, and antiapoptotic effects on hepatic epithelia. ...
... Ocular syphilis is a relatively uncommon manifestation of T. pallidum infection and usually occurs in the secondary and tertiary stages of syphilis and can present as a variety of ocular pathologies, including chancre of the eyelid, conjunctivitis, scleritis, uveitis, chorioretinitis, and optic neuritis. [1][2][3][4][5][6] The diagnosis of syphilis is based upon non-specific serologic tests such as Venereal Disease Research Laboratory test (VDRL) and RPR, and confirmatory treponemal tests such as the fluorescent treponemal antibody absorption (FTA-ABS) test and the microhemagglutination-T. pallidum (MHA-TA) test. Patients presenting with ocular syphilis need to have cerebrospinal fluid examination for central nervous system syphilis. ...
A 51-year-old Caucasian male was referred to neuro-ophthalmology clinic for an evaluation of acute onset of painless visual loss in the left eye. The ocular examination revealed subtle retinal changes suspicious for chorioretinitis. Laboratory workup revealed a reactive Treponema pallidum particle agglutination assay (TP-PA), confirming the diagnosis of ocular syphilis. The patient was treated with intravenous infusion of penicillin with complete recovery of vision and resolution of retinal abnormalities.
... HIV/syphilis co-infection is common because both conditions affect similar risk groups. 1 HIV interferes with the natural history of syphilis, which often has atypical clinical features, and may even mimic Reiter's syndrome. [1][2][3][4] To date, there are only two reports of this rare condition in the literature. 2,3 Some cases present only with syphilitic eczema of the scrotum. ...
... [1][2][3][4] To date, there are only two reports of this rare condition in the literature. 2,3 Some cases present only with syphilitic eczema of the scrotum. 4 Reiter's syndrome is characterized by peripheral seronegative polyarthritis, usually manifesting after dysenteric or urogenital infection. ...
HIV/syphilis co-infection is common because both conditions affect similar risk
groups. HIV interferes with the natural history of syphilis, which often has atypical
clinical features and nervous system involvement in the early stage of disease. We
report the case of an HIV-positive patient with secondary syphilis, scaling
palmoplantar keratoderma, scrotal eczema, balanitis and urethritis mimicking Reiter’s
syndrome. Immunohistochemistry using polyclonal antibodies against Treponema pallidum
revealed the presence of spirochetes, associated with the paretic form of parenchymal
neurosyphilis. The patient was given crystalline penicillin, with complete resolution
of dermatological and neurological symptoms, and no sequelae.
