Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV
Background. An estimated 25% of primary and secondary syphilis, a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum, occurs in patients coinfected with human immunodeficiency virus (HIV) (Chesson et al., 2005). This association is especially evident in men who have...
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Wiley
2021-01-01
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| Series: | Case Reports in Infectious Diseases |
| Online Access: | http://dx.doi.org/10.1155/2021/1124033 |
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| author | Robert Jame Yousif Al-Saeigh Leo L. Wang Kevin Wang |
| author_facet | Robert Jame Yousif Al-Saeigh Leo L. Wang Kevin Wang |
| author_sort | Robert Jame |
| collection | DOAJ |
| description | Background. An estimated 25% of primary and secondary syphilis, a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum, occurs in patients coinfected with human immunodeficiency virus (HIV) (Chesson et al., 2005). This association is especially evident in men who have sex with men (MSM). In HIV-positive patients, primary syphilis infection may progress more rapidly to the tertiary, and most destructive, stage and reinfection can start with the latent or tertiary stage; in such patients, advanced syphilis may arise without clinical warning signs (Kenyan et al., 2018). It is important to note that neurosyphilis can occur during any stage of infection in all patients, regardless of immunocompetence status (CDC, 2021). Case Presentation. A 56-year-old male with a past medical history of well-controlled HIV with a CD4 count of 700 cells/mm3 and an undetectable viral load, psoriasis, and a remote episode of treated syphilis, presented with a two-week history of a diffuse desquamating rash, alopecia, sinusitis, unilateral conjunctivitis, and blurred vision. His last sexual encounter was over ten months ago. The diagnosis of syphilis was confirmed by microhemagglutination assay, and he was treated for presumed neuro-ocular infection with a two-week course of intravenous Penicillin G. Conclusion. Syphilis has acquired a reputation as “the great masquerader” due to its protean manifestations. It may follow an unpredictable course, especially in HIV-positive patients, including those whose treatment has achieved undetectable serology. For example, ocular syphilis may present in an otherwise asymptomatic individual (Rein, 2020) and alopecia may arise as the sole indication of acute syphilitic infection (Doche et al., 2017). Therefore, a high index of suspicion is warranted in order to prevent severe and irreversible complications. |
| format | Article |
| id | doaj-art-a5cc2a8bc48e45cdaacba3f737507731 |
| institution | Kabale University |
| issn | 2090-6633 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Infectious Diseases |
| spelling | doaj-art-a5cc2a8bc48e45cdaacba3f7375077312025-02-03T05:57:19ZengWileyCase Reports in Infectious Diseases2090-66332021-01-01202110.1155/2021/1124033Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIVRobert Jame0Yousif Al-Saeigh1Leo L. Wang2Kevin Wang3Sackler School of MedicinePennsylvania HospitalPennsylvania HospitalRobert Wood Johnson Medical SchoolBackground. An estimated 25% of primary and secondary syphilis, a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum, occurs in patients coinfected with human immunodeficiency virus (HIV) (Chesson et al., 2005). This association is especially evident in men who have sex with men (MSM). In HIV-positive patients, primary syphilis infection may progress more rapidly to the tertiary, and most destructive, stage and reinfection can start with the latent or tertiary stage; in such patients, advanced syphilis may arise without clinical warning signs (Kenyan et al., 2018). It is important to note that neurosyphilis can occur during any stage of infection in all patients, regardless of immunocompetence status (CDC, 2021). Case Presentation. A 56-year-old male with a past medical history of well-controlled HIV with a CD4 count of 700 cells/mm3 and an undetectable viral load, psoriasis, and a remote episode of treated syphilis, presented with a two-week history of a diffuse desquamating rash, alopecia, sinusitis, unilateral conjunctivitis, and blurred vision. His last sexual encounter was over ten months ago. The diagnosis of syphilis was confirmed by microhemagglutination assay, and he was treated for presumed neuro-ocular infection with a two-week course of intravenous Penicillin G. Conclusion. Syphilis has acquired a reputation as “the great masquerader” due to its protean manifestations. It may follow an unpredictable course, especially in HIV-positive patients, including those whose treatment has achieved undetectable serology. For example, ocular syphilis may present in an otherwise asymptomatic individual (Rein, 2020) and alopecia may arise as the sole indication of acute syphilitic infection (Doche et al., 2017). Therefore, a high index of suspicion is warranted in order to prevent severe and irreversible complications.http://dx.doi.org/10.1155/2021/1124033 |
| spellingShingle | Robert Jame Yousif Al-Saeigh Leo L. Wang Kevin Wang Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV Case Reports in Infectious Diseases |
| title | Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV |
| title_full | Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV |
| title_fullStr | Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV |
| title_full_unstemmed | Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV |
| title_short | Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV |
| title_sort | justified suspicion symptomatic syphilitic alopecia in a patient with well controlled hiv |
| url | http://dx.doi.org/10.1155/2021/1124033 |
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