Romero-Jiménez M J, Suárez Lozano I, Fajardo Picó J M, Barón Franco B
Unidad de Enfermedades Infecciosas de Medicina Interna. Hospital Infanta Elena, Huelva, Spain.
An Med Interna. 2003 Jul;20(7):373-6.
Malignant syphilis is an infrequent manifestation of syphilis in HIV infected patients. Only 21 cases have been published in medical literature. Most frequent in men, 62%, the mean age of presentation is 34 years. The most frequent symptoms are: 100% ulcerative cutaneous lesions, 47% fever and 33% ocular affectation. About 80% of the patients have a CD4 count >200. Lues serological test was 100% positive and 81% responded to penicillin. We report a 18 year old woman diagnosed of HIV infection, admitted to our service because of fever, painful oral sores, over-elevated eritematous lesions and cratered ulcers all over the body, with the initial suspicion of chickenpox. Lues serology turned out to be positive, as well as the Warthin Starry stain. After penicillin treatment was initiated, skin lesions improved, although residual lesions currently persist. Malignant syphilis should be considered in infected HIV patients with fever and ulcerated skin injuries as a possible diagnosis. Eventhough serological tests allow diagnosis confirmation, Warthin Starry stain can be useful when serology is negative. The first choice of treatment is penicillin and in case of penicillin allergy, a third generation cefalosporine should be used.
恶性梅毒是梅毒在HIV感染患者中不常见的表现形式。医学文献中仅发表过21例。男性最为常见，占62%，发病的平均年龄为34岁。最常见的症状为：100%有溃疡性皮肤损害，47%发热，33%有眼部病变。约80%的患者CD4细胞计数>200。梅毒血清学检测100%呈阳性，81%对青霉素有反应。我们报告一例18岁诊断为HIV感染的女性，因发热、口腔疼痛性溃疡、全身弥漫性红斑性病变和火山口状溃疡入院，最初怀疑为水痘。梅毒血清学检测结果呈阳性，Warthin Starry染色也呈阳性。开始青霉素治疗后，皮肤病变有所改善，尽管目前仍有残留病变。对于发热且有皮肤溃疡性损伤的HIV感染患者，应考虑恶性梅毒这一可能的诊断。尽管血清学检测可确诊，但当血清学检测为阴性时，Warthin Starry染色可能会有帮助。治疗的首选药物是青霉素，对青霉素过敏时，应使用第三代头孢菌素。
