Case and Research Letter
Secondary Syphilis Mimicking Lichen Planus in a Patient With HIV Coinfection
Sífilis secundaria simulando liquen plano en el paciente con infección por VIH
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B) Estudio histológico: detalle de células plasmáticas perivasculares <span class="elsevierStyleBold">(</span>Hematoxilina-eosina ×40). C) Estudio inmunohistoquímico positivo para <span class="elsevierStyleItalic">Treponema pallidum</span>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "N. Jiménez-Gómez, Á. Hermosa-Gelbard, R. Carrillo-Gijón, P. Jaén" "autores" => array:4 [ 0 => array:2 [ "nombre" => "N." "apellidos" => "Jiménez-Gómez" ] 1 => array:2 [ "nombre" => "Á." "apellidos" => "Hermosa-Gelbard" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Carrillo-Gijón" ] 3 => array:2 [ "nombre" => "P." 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Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>x10.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Ayala, M.D. Ramón, M. Cabezas, E. Jordá" "autores" => array:4 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Ayala" ] 1 => array:2 [ "nombre" => "M.D." "apellidos" => "Ramón" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Cabezas" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Jordá" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000173101600096X" "doi" => "10.1016/j.ad.2016.01.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101600096X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016301469?idApp=UINPBA000044" "url" => "/15782190/0000010700000007/v2_201704140340/S1578219016301469/v2_201704140340/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219016301858" "issn" => "15782190" "doi" => "10.1016/j.adengl.2016.02.025" "estado" => "S300" "fechaPublicacion" => "2016-09-01" "aid" => "1379" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2016;107:610-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 672 "formatos" => array:3 [ "EPUB" => 41 "HTML" => 466 "PDF" => 165 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Majocchi Granuloma of the Breast: A Rare Clinical Entity" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "610" "paginaFinal" => "612" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Granuloma de Majocchi: Una rara entidad" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 600 "Ancho" => 800 "Tamanyo" => 75893 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Complete resolution of the plaque after finishing treatment.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "U. Khanna, T. Kumar Dhali, P. D'Souza, S. Chowdhry" "autores" => array:4 [ 0 => array:2 [ "nombre" => "U." "apellidos" => "Khanna" ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Kumar Dhali" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "D'Souza" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Chowdhry" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0001731016300138" "doi" => "10.1016/j.ad.2016.02.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731016300138?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016301858?idApp=UINPBA000044" "url" => "/15782190/0000010700000007/v2_201704140340/S1578219016301858/v2_201704140340/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>" "titulo" => "Secondary Syphilis Mimicking Lichen Planus in a Patient With HIV Coinfection" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "612" "paginaFinal" => "614" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "N. Jiménez-Gómez, Á. Hermosa-Gelbard, R. Carrillo-Gijón, P. Jaén" "autores" => array:4 [ 0 => array:4 [ "nombre" => "N." "apellidos" => "Jiménez-Gómez" "email" => array:1 [ 0 => "natjgomez@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Á." "apellidos" => "Hermosa-Gelbard" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Carrillo-Gijón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "P." "apellidos" => "Jaén" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sífilis secundaria simulando liquen plano en el paciente con infección por VIH" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1125 "Ancho" => 1500 "Tamanyo" => 428097 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Histologic findings: lichenoid dermatitis with effacement of the basal layer, exocytosis of neutrophils, and a band-like lymphoplasmacytic infiltrate together with numerous plasma cells on the wall and around the vessels of the dermis (hematoxylin-eosin, original magnification ×10). B, Histologic findings: detailed view of perivascular plasma cells (hematoxylin-eosin, original magnification ×40). C, Positive immunohistochemical staining for <span class="elsevierStyleItalic">Treponema pallidum</span>.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Syphilis rates have been on the rise in recent years. In Spain, this sexually transmitted infection mainly affects men who have sex with men (MSM), many of whom are coinfected with human immunodeficiency virus (HIV).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> The natural history of both syphilis and HIV infection is affected by the coexistence of these diseases. The clinical manifestations of syphilis can progress more rapidly in patients with concomitant HIV infection, and aggressive and atypical forms of syphilis are also more common in this population.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of 2 MSM with HIV infection who visited their dermatologist with genital lesions. The first man, aged 35 years, reported slightly pruritic lesions on the genitals that had appeared a month and a half earlier. He had applied topical corticosteroids, but there had been no improvement. Good immunologic control of his HIV infection had been maintained since 2009 without antiretroviral therapy. The physical examination revealed erythematous plaques with a lichenoid appearance and a tendency to coalesce on the dorsal aspect of the penis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> A and B). Blood test results brought by the patient, which included biochemistry, a complete blood count, and coagulation studies, were unremarkable. Skin biopsy revealed lichenoid dermatitis with effacement of the basal layer, exocytosis of neutrophils, and a band-like lymphoplasmacytic infiltrate (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Numerous plasma cells were also observed on the wall and around the vessels of the dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). Immunohistochemical staining for <span class="elsevierStyleItalic">Treponema pallidum</span> was positive (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C). Syphilis serology was requested; the nontreponemal rapid plasma reagin (RPR) test showed antibody titers of 1/128 and the treponemal antibody test was positive.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The second man, aged 29 years, had been diagnosed with HIV infection in 2011 and had achieved good immunologic control without pharmacologic treatment. He presented with mildly pruritic scrotal lesions of 1 month's duration. The lesions had been diagnosed as eczema and treated with topical corticosteroids, but there had been no improvement. The physical examination showed numerous pink plaques with a lichenoid appearance on the scrotum and at the base of the penis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Laboratory tests, including biochemistry, a complete blood count, and coagulation studies, showed no alterations, and serology for syphilis was also negative. Histologic examination of a skin biopsy sample showed lichenoid dermatitis and immunohistochemical staining was positive for <span class="elsevierStyleItalic">T pallidum</span>. The RPR test was positive (titer, 1/64), as were the enzyme-linked immunosorbent assay and hemagglutination results.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Both patients were diagnosed with secondary syphilis mimicking lichen planus, with exclusive genital involvement. The clinical outcome was satisfactory in both cases, with complete resolution of lesions following treatment with intramuscular benzathine penicillin G 2.4 million units and a decline in RPR titers.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Cutaneous manifestations of secondary syphilis appear 3 to 12 weeks after the onset of the primary chancre, although they can occur months later or even before this sore disappears.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> Secondary syphilis typically presents as maculopapular and erythematous scaling lesions, although lichenoid, nodular, and ulcerated lesions may also be observed, though less frequently.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3,4</span></a> HIV infection accelerates the progression of syphilis by altering cell-mediated immunity, and it is sometimes associated with atypical syphilis manifestations.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Known as the <span class="elsevierStyleItalic">great imitator</span>, syphilis is a true diagnostic challenge for clinicians. Although secondary syphilis is known to mimic other diseases (pityriasis rosea, psoriasis,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> sarcoidosis, etc.), lichenoid eruptions are uncommon.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> These eruptions were reported prior to the introduction of penicillin, i.e., when arsenic-based compounds were still being used as the treatment of choice for syphilis, and it was assumed that these compounds for responsible for the lichenoid appearance of the lesions. Similar lesions, however, continued to be observed when they were replaced with penicillin.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> Serology, together with histologic findings, has an important diagnostic role, with positive results shown by both treponemal and nontreponemal tests. Most patients with HIV infection have normal serology, although they may present false-positive nontreponemal responses and higher-than-expected titers in the absence of reinfection. It should also be noted that delayed positives and false negatives are also possible with nontreponemal tests.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The treatment of secondary syphilis in patients with HIV infection has generated some controversy. The latest edition of the Sexually Transmitted Diseases Treatment Guidelines from the Centers for Disease Control<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> recommends a single dose of intramuscular benzathine penicillin G 2.4 million units, regardless of whether the patient has concomitant HIV infection or not, as additional doses have not proven to be more effective.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Although the literature contains reports of secondary syphilis mimicking lichen planus, our cases are interesting in that the lesions were exclusively genital. We found only 2 similar cases in our literature search.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> Both clinicians and pathologists should be aware of the highly variable clinical and histologic features of secondary syphilis to ensure prompt diagnosis and treatment.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Jiménez-Gómez N. Sífilis secundaria simulando liquen plano en el paciente con infección por VIH. Actas Dermosifiliogr. 2016;107:612–614.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 975 "Ancho" => 1300 "Tamanyo" => 168826 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Erythematous, well-delimited plaques with a lichenoid appearance on the dorsal surface of the penis (patient #1). B, Erythematous 3-mm plaque with an erosive center and clear, whitish edges in the same patient.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1125 "Ancho" => 1500 "Tamanyo" => 428097 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Histologic findings: lichenoid dermatitis with effacement of the basal layer, exocytosis of neutrophils, and a band-like lymphoplasmacytic infiltrate together with numerous plasma cells on the wall and around the vessels of the dermis (hematoxylin-eosin, original magnification ×10). B, Histologic findings: detailed view of perivascular plasma cells (hematoxylin-eosin, original magnification ×40). C, Positive immunohistochemical staining for <span class="elsevierStyleItalic">Treponema pallidum</span>.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 735 "Ancho" => 980 "Tamanyo" => 123240 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Photograph showing pinkish lichenoid plaques on the scrotum of patient #2.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increase in syphilis and gonorrhoea among men who have sex with men in Madrid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 19 | 9 | 28 |
| 2024 October | 129 | 48 | 177 |
| 2024 September | 115 | 35 | 150 |
| 2024 August | 163 | 62 | 225 |
| 2024 July | 195 | 42 | 237 |
| 2024 June | 162 | 59 | 221 |
| 2024 May | 146 | 40 | 186 |
| 2024 April | 105 | 29 | 134 |
| 2024 March | 138 | 29 | 167 |
| 2024 February | 133 | 36 | 169 |
| 2024 January | 164 | 41 | 205 |
| 2023 December | 148 | 17 | 165 |
| 2023 November | 129 | 22 | 151 |
| 2023 October | 147 | 30 | 177 |
| 2023 September | 127 | 31 | 158 |
| 2023 August | 87 | 12 | 99 |
| 2023 July | 118 | 29 | 147 |
| 2023 June | 65 | 20 | 85 |
| 2023 May | 129 | 20 | 149 |
| 2023 April | 95 | 13 | 108 |
| 2023 March | 151 | 30 | 181 |
| 2023 February | 135 | 28 | 163 |
| 2023 January | 117 | 24 | 141 |
| 2022 December | 146 | 27 | 173 |
| 2022 November | 80 | 25 | 105 |
| 2022 October | 82 | 15 | 97 |
| 2022 September | 120 | 26 | 146 |
| 2022 August | 119 | 25 | 144 |
| 2022 July | 73 | 33 | 106 |
| 2022 June | 50 | 26 | 76 |
| 2022 May | 111 | 42 | 153 |
| 2022 April | 159 | 28 | 187 |
| 2022 March | 146 | 37 | 183 |
| 2022 February | 138 | 15 | 153 |
| 2022 January | 135 | 35 | 170 |
| 2021 December | 73 | 33 | 106 |
| 2021 November | 92 | 41 | 133 |
| 2021 October | 93 | 50 | 143 |
| 2021 September | 102 | 36 | 138 |
| 2021 August | 85 | 19 | 104 |
| 2021 July | 60 | 25 | 85 |
| 2021 June | 74 | 19 | 93 |
| 2021 May | 81 | 47 | 128 |
| 2021 April | 208 | 43 | 251 |
| 2021 March | 125 | 24 | 149 |
| 2021 February | 76 | 32 | 108 |
| 2021 January | 53 | 18 | 71 |
| 2020 December | 51 | 17 | 68 |
| 2020 November | 28 | 8 | 36 |
| 2020 October | 42 | 6 | 48 |
| 2020 September | 22 | 14 | 36 |
| 2020 August | 44 | 12 | 56 |
| 2020 July | 26 | 17 | 43 |
| 2020 June | 46 | 35 | 81 |
| 2020 May | 35 | 23 | 58 |
| 2020 April | 34 | 21 | 55 |
| 2020 March | 28 | 12 | 40 |
| 2020 February | 5 | 1 | 6 |
| 2019 December | 4 | 0 | 4 |
| 2019 September | 4 | 0 | 4 |
| 2019 June | 2 | 0 | 2 |
| 2019 April | 1 | 1 | 2 |
| 2019 March | 2 | 3 | 5 |
| 2019 January | 2 | 0 | 2 |
| 2018 December | 3 | 0 | 3 |
| 2018 November | 1 | 0 | 1 |
| 2018 October | 2 | 0 | 2 |
| 2018 September | 3 | 0 | 3 |
| 2018 February | 22 | 2 | 24 |
| 2018 January | 44 | 7 | 51 |
| 2017 December | 45 | 3 | 48 |
| 2017 November | 35 | 6 | 41 |
| 2017 October | 47 | 7 | 54 |
| 2017 September | 31 | 1 | 32 |
| 2017 August | 46 | 8 | 54 |
| 2017 July | 29 | 12 | 41 |
| 2017 June | 35 | 7 | 42 |
| 2017 May | 26 | 10 | 36 |
| 2017 April | 23 | 10 | 33 |
| 2017 March | 21 | 7 | 28 |
| 2017 February | 69 | 10 | 79 |
| 2017 January | 21 | 7 | 28 |
| 2016 December | 37 | 24 | 61 |
| 2016 November | 34 | 17 | 51 |
| 2016 October | 29 | 14 | 43 |
| 2016 September | 1 | 1 | 2 |
| 2016 July | 2 | 2 | 4 |
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