Varela P, Alves R, Velho G, Santos C, Massa A, Sanches M
Dermatology and Venereology Departement, Hospital Geral de S. António, Porto, Portugal.
Eur J Dermatol. 1999 Jun;9(4):300-2.
Tertiary syphilis is now a rare disease in Europe, mainly as a result of occasional antibiotherapy for concomitant infections. However early syphilis is rising in USA and Germany, and it is necessary to maintain an high level of knowledge and suspicion to achieve a diagnosis in the tertiary stage of the disease. In this report two patients with benign tertiary syphilis are described. The first one is a 55-year-old female with erythemato-violaceous annular scaling plaques on the right buttock and scapula and on both thighs, which had a negative and then a low VDRL titer. The second case is a 33-year-old mentally handicapped female with erythematous plaques, with psoriasiform scaling in the trunk and well defined crusted ulcers on the face, which also had negative VDRL. Biopsy of the skin lesions revealed plasmocytic infiltrate with endothelial swelling without granulomas and with negative silver stains in both patients. The investigation for cardiovascular and neurological involvement was negative in both patients. Diagnosis of tertiary syphilis can be difficult as clinical pictures can be misleading, similar to other granulomatous diseases, and serological titers can be low or negative. We recall the necessity of ruling out neurological and cardiac involvement in this stage of syphilis. These cases are reported as a reminder of the possibility of syphilis, so that new cases are not misdiagnosed and mistreated as other diseases.
三期梅毒在欧洲现已成为一种罕见疾病，主要是由于对合并感染进行了偶然的抗微生物治疗。然而，早期梅毒在美国和德国呈上升趋势，因此有必要保持高度的认识和怀疑态度，以便在疾病的三期做出诊断。在本报告中，描述了两名良性三期梅毒患者。第一名患者是一名55岁女性，右臀部、肩胛骨和双大腿出现红斑性紫罗兰色环状鳞屑斑块，梅毒血清试验（VDRL）最初呈阴性，之后滴度较低。第二例是一名33岁的智障女性，躯干有红斑性斑块，伴有银屑病样鳞屑，面部有边界清晰的结痂溃疡，VDRL也呈阴性。两名患者的皮肤病变活检均显示浆细胞浸润伴内皮肿胀，无肉芽肿，银染色阴性。两名患者的心血管和神经受累检查均为阴性。三期梅毒的诊断可能很困难，因为临床表现可能会产生误导，与其他肉芽肿性疾病相似，而且血清学滴度可能较低或呈阴性。我们再次强调在梅毒的这一阶段排除神经和心脏受累的必要性。报告这些病例是为了提醒人们注意梅毒的可能性，以免新病例被误诊并被当作其他疾病治疗。
