Abstract
IntroductionUntreated syphilis may lead to severe complications. This infection has recently re-emerged in developed countries with a high number of cases coinfected with human immunodeficiency virus. In these patients, the skin lesions of secondary syphilis can be very atypical.Case presentationWe report the case of a 38-year-old Bulgarian homosexual man who was coinfected with human immunodeficiency virus and syphilis. His skin contained multiple extensive necrotic lesions with abundant purulent secretion that covered his face, lips, scalp, and torso. Initial clinical diagnoses included varicella pustulosa and staphylococcal dermatitis. Human immunodeficiency virus infection in our patient had been established 2 years earlier in prophylactic studies, but had not been treated. Due to lack of penicillin, he was successfully treated with ceftriaxone, and the skin lesions underwent complete reversal. He also began antiretroviral therapy, which resulted in a significant effect on his immune status. Three months after the onset of antiretroviral therapy, he also achieved optimal viral suppression.ConclusionThis case emphasizes the importance of considering cutaneous secondary syphilis in the differential diagnosis of any inflammatory cutaneous disorder in individuals infected with human immunodeficiency virus.
Highlights
Untreated syphilis may lead to severe complications
The case we present is unusual in the severity and the characteristics of the skin lesions that were not typical of secondary syphilis
It was established that 2 years earlier in prophylactic studies, he had been diagnosed as having an human immunodeficiency virus (HIV) infection and his result had been confirmed by the National Reference Laboratory for HIV in Sofia, Bulgaria
Summary
Syphilis has been known as “the great imitator” due to its wide variability in clinical presentation [1, 2]. Case presentation We present the case of a 38-year-old Bulgarian homosexual man who was HIV-seropositive According to his own account, he had several sexual partners and worked as a physical therapist. Following an out-patient visit to another dermatologist, he had been referred for syphilis and HIV testing. It was established that 2 years earlier in prophylactic studies, he had been diagnosed as having an HIV infection and his result had been confirmed by the National Reference Laboratory for HIV in Sofia, Bulgaria. He claimed that he had not been aware of the diagnosis and had not been treated for it. As of May 2019, our patient has not visited our Department, and has not been followed up since
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
