Malignant syphilis as an atypical clinical manifestation of secondary syphilis

Abstract

Malignant syphilis (MS) is a rare form of secondary syphilis. The pathogenesis is unknown; however, it is recognized that it is more common in immunocompromised patients or in patients with poor health, and mainly in patients with HIV coinfection. Within the clinical manifestations of secondary syphilis, mucocutaneous and systemic findings can be found. MS shares a tropism with secondary syphilis, so skin lesions can be found on the trunk, extremities, mucous membranes, palms of the hands, soles of the feet, and scalp. These lesions are characterized by disseminated pustules that tend to evolve into nodular lesions with a necrotic center and/or hyperkeratosis. The diagnosis is based on the patient's symptoms, confirmation by dark field microscopy, serology, and characteristic histology such as infiltrates of lymphocytes and plasma cells in the dermis. The treatment of choice is penicillin, like all patients with syphilis. Being a sexually transmitted disease, it is essential to evaluate the patient's sexual partners and provide them with treatment.