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April 1992

An Unusual Presentation of Secondary Syphilis in a Patient With Human Immunodeficiency Virus Infection: A Case Report and Review of the Literature

Author Affiliations

From the Departments of Dermatology and Pathology, Division of Dermatopathology, University of Texas Southwestern Medical Center at Dallas (Drs Glover and Cockerell), and the Department of Dermatology, University of California at San Diego (Drs Piaquadio and Kern). Dr Glover is now in private practice, Wilson, NC.

Arch Dermatol. 1992;128(4):530-534. doi:10.1001/archderm.1992.01680140110014

• Background.—  Syphilis has been reported to assume unusual clinical appearances and to exhibit unusual courses in patients infected with the human immunodeficiency virus (HIV) type 1. We recently observed a distinct manifestation of syphilis in an HIV-infected patient with features not previously described.

Observations.—  A 38-year-old HIV-seropositive homosexual man presented with fever, chills, malaise, and a cutaneous eruption consisting of indurated, shiny, erythematous plaques that were confluent on the face and scalp leading to alopecia and extreme tautness of the skin. Initial clinical diagnoses included lymphoreticular malignancy and infection. Although cultures yielded Staphylococcus aureus, a skin biopsy specimen was diagnostic of syphilis.

Conclusions.—  This case demonstrates an unusual clinical manifestation of syphilis in a patient with HIV infection and emphasizes the importance of considering cutaneous secondary syphilis in the differential diagnosis of virtually any inflammatory cutaneous disorder in HIV-seropositive individuals.(Arch Dermatol. 1992;128:530-534)

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