Internal Medicine Flashcard
An elderly woman with ulceronodular rash

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Introduction

An 86-year-old woman affected by mild cognitive impairment presented to our institution with complaints of intense headache, vomiting and fever since 2 days, complicating a 4-month history of mucosal ulcerations and progressive papulopustular skin lesions of the whole body. She had been diagnosed with scleroatrophic lichen, and a biopsy of the tongue had shown epithelial ulceration and an intense perivascular inflammatory infiltrate of the lamina propria rich in plasma cells. On examination, the patient was febrile but alert; no neck stiffness or change in mental status were present. Skin lesions consisted of multiple erythematous, keratotic papules and nodules, some of which ulcerated and covered by adherent crusts. The lesions ranged from 5 to 20 mm in size and involved the face, the trunk and the extremities. The lumbosacral region was interested by a large eczematous-like plaque, of 70 × 40 mm. Examination of soles showed faint, scaly maculopapules; palms were spared. The tongue presented coalescent ulcerated, painless lesions covered by whitish pseudomembranes; the anovulvar region was interested by keratotic and ulcerated papules and plaques (Fig. 1).

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Diagnosis

Treponema pallidum hemagglutination assay (TPHA) tested positive with a titer of 1:10,240, venereal disease research laboratory (VDRL) was strongly reactive. According to clinical, hysthological and serological findings, a diagnosis of malignant syphilis was posed. A concomitant neurosyphilis was excluded by cerebrospinal fluid examination. Serology for HIV tested negative. The patient was treated with a 14-day course of ceftriaxone, achieving rapid recovery and a complete healing of skin and

Conflict of interests

The authors state that they have no conflicts of interest.

References (3)

  • C.B. Requena

    Malignant syphilis in an immunocompetent female patient

    An Bras Dermatol

    (2014)
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