Blastomycosis-Like Pyoderma in a Patient with Syphilis and HIV Resolving with Antibiotic Therapy

Abstract

Blastomycosis-like pyoderma (BLP) is a rare, exaggerated, vegetative tissue reaction that occurs in patients with local or systemic immune dysregulation. Reported causes of immune compromise include human immunodeficiency virus, malnutrition, alcoholism, leukemia, immunosuppressant use, radiation therapy, and others. Nearly all cases involve an underlying, prolonged pyogenic bacterial infection. Historically monotherapy with systemic antibiotics requires long-term treatment and often fails. We describe a case of a male patient with BLP of the face and scalp, which cultured positive for methicillin-resistant Staphylococcus aureus (MRSA). Subsequent evaluation uncovered a concurrent Treponema pallidum and HIV infections. Treatment of the MRSA with a short course of doxycycline and the syphilis with penicillin, resulted in complete resolution of the skin lesions. Highly Active Anti-Retroviral Therapy for HIV was initiated after the skin lesions had cleared. Resolution of BLP by antibiotic therapy alone in the context of untreated HIV leads the authors to postulate that syphilis may have been the relevant factor contributing to his immune dysregulation.