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This was characterized by the presence of violaceous&#44; infiltrated papules&#44; some of which were excoriated and crusted &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Laboratory testing revealed the following relevant findings&#58; CD4&#44; 151 cells&#47;&#181;L&#59; viral load&#44; 2315 copies&#47;mL&#44; and positive VDRL &#40;1&#47;2 dilution&#41;&#46; A new biopsy revealed a hyperplastic and acanthotic epidermis&#44; with focal vacuolization of the basal layer and abundant lymphohistiocytic infiltrate&#44; as well as multiple eosinophils around the superficial and deep dermal vessels and hair and eccrine follicles&#44; extending to the epithelium and to the subcutaneous tissue&#46; These findings were compatible with pruritic papular eruption &#40;PPE&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The correlation between the clinical and laboratory findings pointed to a diagnosis of HIV-associated PPE&#46; Antiretroviral therapy was restarted&#44; and symptoms were treated with oral antihistamines and topical corticosteroids&#46; The patient&#8217;s condition improved markedly&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Syphilis is a sexually transmitted infection that can present as primary&#44; secondary&#44; or tertiary disease&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Secondary syphilis is characterized by generalized nummular erythematous macules mainly affecting the trunk&#44; the proximal part of the limbs&#44; the palms&#44; the soles&#44; and the mucous membranes&#46; Also typical are patchy alopecia&#44; fever&#44; dysphagia&#44; arthralgia&#44; general malaise&#44; weight loss&#44; headache&#44; and meningism&#46; During this phase&#44; the patient is highly contagious&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Malignant syphilis is an ulcerative variant of secondary syphilis&#46; It was first described in 1859 by Bazin&#46; The word &#8220;malignant&#8221; stems from the clinical similarity between this disease and skin cancer&#44; although it is not a cancer&#46; Its incidence is unknown&#44; and it is associated with immunodepression &#40;HIV&#44; diabetes&#41;&#44; although not exclusively&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Onset is at between 6 weeks and 1 &#8239;year after the primary infection&#44; or even earlier in immunodepressed patients&#46; It is characterized by the presence of papules or pustules that easily become ulcerated&#46; The ulcers are round or oval&#44; with raised&#44; well-defined borders and a necrotic or rupioid center&#46; The rash may be associated with other symptoms&#44; such as diarrhea&#44; vomiting&#44; and hepatosplenomegaly&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">While uncommon&#44; malignant syphilis could be an early manifestation in HIV-infected patients with a CD4 T-lymphocyte count &#60;&#8239;200 cells&#47;&#181;L&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The diagnosis is usually confirmed based on the Fisher criteria&#44; as follows&#58; &#40;<span class="elsevierStyleItalic">1</span>&#41; compatible morphology&#59; &#40;<span class="elsevierStyleItalic">2</span>&#41; positive serology test result for syphilis&#59; &#40;<span class="elsevierStyleItalic">3</span>&#41; Jarisch-Herxheimer reaction to treatment&#59; and &#40;<span class="elsevierStyleItalic">4</span>&#41; dramatic response to antibiotic therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Jarisch-Herxheimer reaction is characterized by general malaise and fever associated with initiation of therapy&#46; Pathophysiology is controversial&#44; although it is thought to result from the inflammatory response that arises after the destruction of spirochetes&#44; which is usually severe in HIV-infected patients&#46; The reaction often occurs in patients receiving treatment for syphilis&#59; nevertheless&#44; it can also occur in other diseases&#44; such as Lyme disease and leptospirosis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The recommended treatment is 3 &#8239;doses of intramuscular benzathine penicillin 2 400 000 IU per week&#46; Administration of systemic corticosteroids to prevent Jarisch-Herxheimer reaction has not been standardized&#44; although several studies report use of methylprednisolone&#44; hydrocortisone&#44; and prednisone before the first dose of penicillin in order to prevent or relieve symptoms&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;7&#44;8</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Furthermore&#44; PPE is associated with HIV infection&#46; Its etiology is under study&#44; and some studies indicate that in HIV-infected patients&#44; it could be due to an altered immune response to insect bites&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Farsani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> reported the association between this disease and a CD4 T-lymphocyte count &#60;&#8239;200 cells&#47;&#181;L&#44; which is consistent with our findings&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In summary&#44; we report the case of a patient with malignant syphilis&#44; an uncommon condition that may be the initial manifestation of immunosuppressive systemic diseases&#46; We also highlight the need for follow-up of HIV-infected patients by the dermatology department&#44; since this population is susceptible to developing skin conditions associated with inadequate control of the underlying disease&#44; such as PPE&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of Interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Granizo-Rubio J&#44; Caviedes-Vallejo C&#44; Ch&#225;vez-D&#225;vila N&#44; Pinos-Le&#243;n V&#46; S&#237;filis maligna y erupci&#243;n papular pruriginosa en un paciente VIH positivo&#46; Actas Dermosifiliogr&#46; 2020&#59;111&#58;269&#8211;271&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Initial clinical image&#46; A&#44; Multiple smooth&#44; well-defined erythematous-violaceous papules and nodules&#46; B&#44; Palms&#46; C&#44; Soles&#46; D&#44; Left thigh showing well-defined ulcers with a violaceous border and dirty base&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Skin biopsy of the new lesions&#46; Hematoxylin-eosin&#46; A&#44; &#215;10&#46; Note acanthosis&#44; network hyperplasia&#44; and focal vacuolization of the basal layer&#46; Superficial and deep dermis&#44; showing a perivascular and periadnexal lymphohistiocytic infiltrate with exocytosis of numerous eosinophils into the epithelium that extends to the subcutaneous tissue&#46; B&#44; &#215;40&#46; Detail of cellular infiltrate&#46; Data compatible with pruritic papular eruption&#46;</p>"
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      "seccion" => array:1 [
        0 => array:2 [
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            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early malignant syphilis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Y&#46; Martins-Ortigosa"
                            1 => "A&#46; Marques-Barbosa"
                            2 => "P&#46; Salomao-Bendazzoli"
                            3 => "L&#46; Martins-Ortigosa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Bras Dermatol"
                        "fecha" => "2016"
                        "volumen" => "5"
                        "paginaInicial" => "5148"
                        "paginaFinal" => "5150"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant syphilis in a HIV infected patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Jalili"
                            1 => "M&#46; Mosleh"
                            2 => "K&#46; Grabmeier-Pfistershammer"
                            3 => "R&#46; Loewe"
                            4 => "G&#46; Stingl"
                            5 => "A&#46; Rieger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.olq.0000462908.84464.52"
                      "Revista" => array:6 [
                        "tituloSerie" => "Sex Transm Dis"
                        "fecha" => "2015"
                        "volumen" => "42"
                        "paginaInicial" => "223"
                        "paginaFinal" => "225"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25763666"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An overview of sexually transmitted diseases&#58; Part I"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46;J&#46; Brown"
                            1 => "A&#46; Yen-Moore"
                            2 => "S&#46;K&#46; Tyring"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAAD"
                        "fecha" => "1999"
                        "volumen" => "41"
                        "paginaInicial" => "511"
                        "paginaFinal" => "532"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10495370"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multiple skin ulcers from malignant syphilis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;H&#46; Li"
                            1 => "H&#46; Guo"
                            2 => "X&#46;H&#46; Gao"
                            3 => "H&#46;D&#46; Chen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2015"
                        "volumen" => "356"
                        "paginaInicial" => "1564"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant syphilis&#58;ostraceous&#44; ulceronecrotic lesions in a patient with humen immunodeficiency virus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46; Mohan"
                            1 => "R&#46;A&#46; Ali"
                            2 => "C&#46;L&#46; Isache"
                            3 => "R&#46;K&#46; Sharma"
                            4 => "C&#46; Perniciario"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "DOJ"
                        "fecha" => "2017"
                        "volumen" => "23"
                        "paginaInicial" => "5"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant syphilis&#58; a review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46; Kumar"
                            1 => "S&#46; Muralidhar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1089/apc.1998.12.921"
                      "Revista" => array:6 [
                        "tituloSerie" => "AIDS Patient Care STDS"
                        "fecha" => "1998"
                        "volumen" => "12"
                        "paginaInicial" => "921"
                        "paginaFinal" => "925"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11362063"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant syphilis in an AIDS patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46;R&#46; Dos Santos"
                            1 => "I&#46;J&#46; De Castro"
                            2 => "M&#46; Dahia"
                            3 => "M&#46; De Azevedo"
                            4 => "G&#46; Da Silva"
                            5 => "R&#46; Motta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s15010-014-0698-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Infection"
                        "fecha" => "2015"
                        "volumen" => "43"
                        "paginaInicial" => "231"
                        "paginaFinal" => "236"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25408098"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathologically confirmed malignant syphilis in an HIV-infected patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Yanagisawa"
                            1 => "M&#46; Ando"
                            2 => "A&#46; Imamura"
                            3 => "K&#46; Akagi"
                            4 => "S&#46; Horiguchi"
                            5 => "A&#46; Suganuma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2169/internalmedicine.50.5605"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intern Med"
                        "fecha" => "2011"
                        "volumen" => "50"
                        "paginaInicial" => "2423"
                        "paginaFinal" => "2426"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22001480"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etiology of pruritic papular eruption with HIV infection in Uganda"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;S&#46; Resneck"
                            1 => "M&#46; van Beek"
                            2 => "L&#46; Furmanski"
                            3 => "J&#46; Oyugi"
                            4 => "P&#46;E&#46; Leboit"
                            5 => "E&#46; Katabira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.292.21.2614"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2004"
                        "volumen" => "292"
                        "paginaInicial" => "2614"
                        "paginaFinal" => "2621"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15572719"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etiology and risk factors associated with a pruritic papular eruption in people living with HIV in India"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46;T&#46; Farsani"
                            1 => "S&#46; Kore"
                            2 => "P&#46; Nadol"
                            3 => "M&#46; Ramam"
                            4 => "S&#46;J&#46; Thierman"
                            5 => "K&#46; Leslie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7448/IAS.16.1.17325"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Int AIDS Soc&#46;"
                        "fecha" => "2013"
                        "volumen" => "16"
                        "paginaInicial" => "17325"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24004854"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spectrum of mucocutaneous manifestations in human immunodeficiency virus-infected patients and its correlation with CD4 lymphocyte count"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;S&#46; Fernandes"
                            1 => "R&#46;M&#46; Bhat"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J STD AIDS"
                        "fecha" => "2015"
                        "volumen" => "26"
                        "paginaInicial" => "414"
                        "paginaFinal" => "419"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
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Case and Research Letters
Malignant Syphilis and Pruritic Papular Eruption in an HIV-Positive Man
Sífilis maligna y erupción papular pruriginosa en un paciente VIH positivo
J. Granizo-Rubioa,
Corresponding author
rubiodaniela94@gmail.com

Corresponding author.
, C. Caviedes-Vallejoa, N. Chávez-Dávilab, V. Pinos-Leónc
a Servicio de Dermatología, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
b Universidad Central del Ecuador, Quito, Ecuador
c DermaAID, Quito, Ecuador
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These were painful to touch &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Microscopy with hematoxylin-eosin staining revealed ulceration of the epidermis&#44; acanthosis&#44; spongiosis&#44; and a damaged basal layer&#44; with microabscesses that open to the surface&#46; A nodular&#44; perivascular&#44; and periadnexal inflammatory infiltrate comprising mainly plasma cells&#44; lymphocytes&#44; and histiocytes was observed in the superficial and deep dermis&#46; These findings were compatible with secondary syphilis&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Warthin-Starry&#44; May-Gr&#252;nwald&#44; and Giemsa staining did not reveal spirochetes&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The significant laboratory findings were as follows&#58; venereal disease research laboratory &#40;VDRL&#41; test&#44; positive &#40;1&#47;16 dilution&#41;&#59; human immunodeficiency virus &#40;HIV&#41; p24 antigen assay&#44; 482&#46;80&#59; CD4&#44; 120 cells&#47;&#181;L&#59; viral load&#44; 2150 copies&#47;mL&#59; syphilis&#44; 205&#46;20&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patient was diagnosed with malignant syphilis and HIV infection and prescribed benzathine penicillin 2 400 000 IU per week for 3 weeks&#46; The treatment led to a self-limiting Jarisch-Herxheimer reaction that did not require treatment&#46; At the end of treatment&#44; the active lesions resolved&#44; with multiple residual pigmented patches&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient did not attend the scheduled appointments for 11 months&#46; He visited again with pruritic lesions on the arms and face that had first appeared 1 month earlier&#46; The physical examination revealed localized dermatosis on the face and distal areas of the upper limbs&#46; This was characterized by the presence of violaceous&#44; infiltrated papules&#44; some of which were excoriated and crusted &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Laboratory testing revealed the following relevant findings&#58; CD4&#44; 151 cells&#47;&#181;L&#59; viral load&#44; 2315 copies&#47;mL&#44; and positive VDRL &#40;1&#47;2 dilution&#41;&#46; A new biopsy revealed a hyperplastic and acanthotic epidermis&#44; with focal vacuolization of the basal layer and abundant lymphohistiocytic infiltrate&#44; as well as multiple eosinophils around the superficial and deep dermal vessels and hair and eccrine follicles&#44; extending to the epithelium and to the subcutaneous tissue&#46; These findings were compatible with pruritic papular eruption &#40;PPE&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The correlation between the clinical and laboratory findings pointed to a diagnosis of HIV-associated PPE&#46; Antiretroviral therapy was restarted&#44; and symptoms were treated with oral antihistamines and topical corticosteroids&#46; The patient&#8217;s condition improved markedly&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Syphilis is a sexually transmitted infection that can present as primary&#44; secondary&#44; or tertiary disease&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Secondary syphilis is characterized by generalized nummular erythematous macules mainly affecting the trunk&#44; the proximal part of the limbs&#44; the palms&#44; the soles&#44; and the mucous membranes&#46; Also typical are patchy alopecia&#44; fever&#44; dysphagia&#44; arthralgia&#44; general malaise&#44; weight loss&#44; headache&#44; and meningism&#46; During this phase&#44; the patient is highly contagious&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Malignant syphilis is an ulcerative variant of secondary syphilis&#46; It was first described in 1859 by Bazin&#46; The word &#8220;malignant&#8221; stems from the clinical similarity between this disease and skin cancer&#44; although it is not a cancer&#46; Its incidence is unknown&#44; and it is associated with immunodepression &#40;HIV&#44; diabetes&#41;&#44; although not exclusively&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Onset is at between 6 weeks and 1 &#8239;year after the primary infection&#44; or even earlier in immunodepressed patients&#46; It is characterized by the presence of papules or pustules that easily become ulcerated&#46; The ulcers are round or oval&#44; with raised&#44; well-defined borders and a necrotic or rupioid center&#46; The rash may be associated with other symptoms&#44; such as diarrhea&#44; vomiting&#44; and hepatosplenomegaly&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">While uncommon&#44; malignant syphilis could be an early manifestation in HIV-infected patients with a CD4 T-lymphocyte count &#60;&#8239;200 cells&#47;&#181;L&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The diagnosis is usually confirmed based on the Fisher criteria&#44; as follows&#58; &#40;<span class="elsevierStyleItalic">1</span>&#41; compatible morphology&#59; &#40;<span class="elsevierStyleItalic">2</span>&#41; positive serology test result for syphilis&#59; &#40;<span class="elsevierStyleItalic">3</span>&#41; Jarisch-Herxheimer reaction to treatment&#59; and &#40;<span class="elsevierStyleItalic">4</span>&#41; dramatic response to antibiotic therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Jarisch-Herxheimer reaction is characterized by general malaise and fever associated with initiation of therapy&#46; Pathophysiology is controversial&#44; although it is thought to result from the inflammatory response that arises after the destruction of spirochetes&#44; which is usually severe in HIV-infected patients&#46; The reaction often occurs in patients receiving treatment for syphilis&#59; nevertheless&#44; it can also occur in other diseases&#44; such as Lyme disease and leptospirosis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The recommended treatment is 3 &#8239;doses of intramuscular benzathine penicillin 2 400 000 IU per week&#46; Administration of systemic corticosteroids to prevent Jarisch-Herxheimer reaction has not been standardized&#44; although several studies report use of methylprednisolone&#44; hydrocortisone&#44; and prednisone before the first dose of penicillin in order to prevent or relieve symptoms&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;7&#44;8</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Furthermore&#44; PPE is associated with HIV infection&#46; Its etiology is under study&#44; and some studies indicate that in HIV-infected patients&#44; it could be due to an altered immune response to insect bites&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Farsani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> reported the association between this disease and a CD4 T-lymphocyte count &#60;&#8239;200 cells&#47;&#181;L&#44; which is consistent with our findings&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In summary&#44; we report the case of a patient with malignant syphilis&#44; an uncommon condition that may be the initial manifestation of immunosuppressive systemic diseases&#46; We also highlight the need for follow-up of HIV-infected patients by the dermatology department&#44; since this population is susceptible to developing skin conditions associated with inadequate control of the underlying disease&#44; such as PPE&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of Interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Granizo-Rubio J&#44; Caviedes-Vallejo C&#44; Ch&#225;vez-D&#225;vila N&#44; Pinos-Le&#243;n V&#46; S&#237;filis maligna y erupci&#243;n papular pruriginosa en un paciente VIH positivo&#46; Actas Dermosifiliogr&#46; 2020&#59;111&#58;269&#8211;271&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Initial clinical image&#46; A&#44; Multiple smooth&#44; well-defined erythematous-violaceous papules and nodules&#46; B&#44; Palms&#46; C&#44; Soles&#46; D&#44; Left thigh showing well-defined ulcers with a violaceous border and dirty base&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical image of the new lesions&#46; Violaceous&#44; infiltrated papules&#44; some of which are excoriated and crusted&#44; on the face &#40;A&#41; and distal area of the upper limbs &#40;B-D&#41;&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Skin biopsy of the new lesions&#46; Hematoxylin-eosin&#46; A&#44; &#215;10&#46; Note acanthosis&#44; network hyperplasia&#44; and focal vacuolization of the basal layer&#46; Superficial and deep dermis&#44; showing a perivascular and periadnexal lymphohistiocytic infiltrate with exocytosis of numerous eosinophils into the epithelium that extends to the subcutaneous tissue&#46; B&#44; &#215;40&#46; Detail of cellular infiltrate&#46; Data compatible with pruritic papular eruption&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:11 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early malignant syphilis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Y&#46; Martins-Ortigosa"
                            1 => "A&#46; Marques-Barbosa"
                            2 => "P&#46; Salomao-Bendazzoli"
                            3 => "L&#46; Martins-Ortigosa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Bras Dermatol"
                        "fecha" => "2016"
                        "volumen" => "5"
                        "paginaInicial" => "5148"
                        "paginaFinal" => "5150"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant syphilis in a HIV infected patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Jalili"
                            1 => "M&#46; Mosleh"
                            2 => "K&#46; Grabmeier-Pfistershammer"
                            3 => "R&#46; Loewe"
                            4 => "G&#46; Stingl"
                            5 => "A&#46; Rieger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.olq.0000462908.84464.52"
                      "Revista" => array:6 [
                        "tituloSerie" => "Sex Transm Dis"
                        "fecha" => "2015"
                        "volumen" => "42"
                        "paginaInicial" => "223"
                        "paginaFinal" => "225"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25763666"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An overview of sexually transmitted diseases&#58; Part I"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46;J&#46; Brown"
                            1 => "A&#46; Yen-Moore"
                            2 => "S&#46;K&#46; Tyring"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAAD"
                        "fecha" => "1999"
                        "volumen" => "41"
                        "paginaInicial" => "511"
                        "paginaFinal" => "532"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10495370"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multiple skin ulcers from malignant syphilis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;H&#46; Li"
                            1 => "H&#46; Guo"
                            2 => "X&#46;H&#46; Gao"
                            3 => "H&#46;D&#46; Chen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2015"
                        "volumen" => "356"
                        "paginaInicial" => "1564"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant syphilis&#58;ostraceous&#44; ulceronecrotic lesions in a patient with humen immunodeficiency virus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46; Mohan"
                            1 => "R&#46;A&#46; Ali"
                            2 => "C&#46;L&#46; Isache"
                            3 => "R&#46;K&#46; Sharma"
                            4 => "C&#46; Perniciario"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "DOJ"
                        "fecha" => "2017"
                        "volumen" => "23"
                        "paginaInicial" => "5"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant syphilis&#58; a review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46; Kumar"
                            1 => "S&#46; Muralidhar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1089/apc.1998.12.921"
                      "Revista" => array:6 [
                        "tituloSerie" => "AIDS Patient Care STDS"
                        "fecha" => "1998"
                        "volumen" => "12"
                        "paginaInicial" => "921"
                        "paginaFinal" => "925"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11362063"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant syphilis in an AIDS patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46;R&#46; Dos Santos"
                            1 => "I&#46;J&#46; De Castro"
                            2 => "M&#46; Dahia"
                            3 => "M&#46; De Azevedo"
                            4 => "G&#46; Da Silva"
                            5 => "R&#46; Motta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s15010-014-0698-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Infection"
                        "fecha" => "2015"
                        "volumen" => "43"
                        "paginaInicial" => "231"
                        "paginaFinal" => "236"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25408098"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathologically confirmed malignant syphilis in an HIV-infected patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Yanagisawa"
                            1 => "M&#46; Ando"
                            2 => "A&#46; Imamura"
                            3 => "K&#46; Akagi"
                            4 => "S&#46; Horiguchi"
                            5 => "A&#46; Suganuma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2169/internalmedicine.50.5605"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intern Med"
                        "fecha" => "2011"
                        "volumen" => "50"
                        "paginaInicial" => "2423"
                        "paginaFinal" => "2426"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22001480"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etiology of pruritic papular eruption with HIV infection in Uganda"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;S&#46; Resneck"
                            1 => "M&#46; van Beek"
                            2 => "L&#46; Furmanski"
                            3 => "J&#46; Oyugi"
                            4 => "P&#46;E&#46; Leboit"
                            5 => "E&#46; Katabira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.292.21.2614"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2004"
                        "volumen" => "292"
                        "paginaInicial" => "2614"
                        "paginaFinal" => "2621"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15572719"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etiology and risk factors associated with a pruritic papular eruption in people living with HIV in India"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46;T&#46; Farsani"
                            1 => "S&#46; Kore"
                            2 => "P&#46; Nadol"
                            3 => "M&#46; Ramam"
                            4 => "S&#46;J&#46; Thierman"
                            5 => "K&#46; Leslie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7448/IAS.16.1.17325"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Int AIDS Soc&#46;"
                        "fecha" => "2013"
                        "volumen" => "16"
                        "paginaInicial" => "17325"
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Article information
ISSN: 15782190
Original language: English
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Idiomas
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