Images in Dermatology
Annular Plaques on the Foreskin and Scrotum in the Context of Secondary Reinfection Syphilis
Placas anulares en el prepucio y el escroto en el contexto de una sífilis secundaria reinfección
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A. Múltiples melanófagos sobre un fondo de fibrosis en la parte superior y necrosis intensa en la parte inferior (hematoxilina y eosina, ×10). B. Melanófagos y CTV con mucha melanina intracitoplasmática, haciendo necesario el uso de técnicas adicionales como el marcador nuclear SOX10 para evaluar el porcentaje de CTV y, por tanto, el tipo de respuesta patológica (hematoxilina y eosina, ×20). C. Melanófagos a la izquierda con melanina intracitoplasmática (marcados con verde), y a la derecha CTV aisladas (marcadas con rojo) (hematoxilina y eosina ×100). D. Captación nuclear para las CTV (marcadas con rojo) y captación citoplasmática de los melanófagos sin tinción nuclear (marcados con verde) (inmunohistoquímica para SOX10, ×100).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Navarro Navarro, D. Jiménez Gallo, M.T. Fernández Morano, I. Villegas Romero, M.I. Catalina Fernández, M. Linares Barrios" "autores" => array:6 [ 0 => array:2 [ "nombre" => "I." 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Martin-Gorgojo" "autores" => array:3 [ 0 => array:3 [ "nombre" => "P." "apellidos" => "Ruiz-Mesa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Blanco-Calvo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "A." "apellidos" => "Martin-Gorgojo" "email" => array:1 [ 0 => "alejandromartingorgojo@aedv.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Centro de Atención Primaria Antonio Gutiérrez, Unidad Docente de Atención Primaria de León, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de ITS/Dermatología, Sección de Especialidades Médicas, Ayuntamiento de Madrid, 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" => "Placas anulares en el prepucio y el escroto en el contexto de una sífilis secundaria reinfección" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 401 "Ancho" => 1256 "Tamanyo" => 105105 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 40-year-old cis-gender homosexual male patient with a history of HIV infection (undetectable viral load, CD4 count within the normal range, receiving dolutegravir/lamivudine) and 2 episodes of secondary syphilis in the past, attended the clinic for assessment of a desquamative, asymptomatic, erythematous plaque with an annular pattern on the foreskin (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Given the circinate appearance of the lesion, he was treated with antifungal and anti-inflammatory cream and screened for venereal infections.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">At the follow-up visit, the lesion on the foreskin had not improved, and new asymptomatic lesions were identified on the scrotum (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) and on the dorsum of the tongue (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). Serology revealed immunoglobulin G and M against <span class="elsevierStyleItalic">Treponema pallidum</span>, with a rapid plasma reagin titer of 1:32. The other screening tests did not reveal additional findings. Given the diagnosis of secondary reinfection syphilis (supported by the positive rapid plasma reagin results with a 1/1 titer 3 months earlier), we administered a single intramuscular dose of benzylpenicillin G benzathine (2.4 million IU). The lesions had improved 1 week after treatment.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The incidence of syphilis is growing, and clinical presentation can be diverse. Cases of reinfection are less well characterized and may present with more subtle cutaneous findings, as in the present case. We report a case of psoriasiform and annular syphilis. The low frequency of this form of syphilis led us to varied differential diagnoses.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">No funding was received for the present study.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 401 "Ancho" => 1256 "Tamanyo" => 105105 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000011400000001/v1_202301060625/S0001731022009279/v1_202301060625/en/main.assets" "Apartado" => array:4 [ "identificador" => "83194" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Imágenes en Dermatología" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000011400000001/v1_202301060625/S0001731022009279/v1_202301060625/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731022009279?idApp=UINPBA000044" ]
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