Schrader A M R Anne-Roos, Rácz Emöke, Noordhoek Hegt Vincent, van der Snoek Eric M, van Praag Marinus C G
Sint Franciscus Gasthuis, Afd. Dermatologie, Rotterdam, the Netherlands.
Ned Tijdschr Geneeskd. 2012;155(33):A5130.
Due to a great diversity of clinical presentations secondary syphilis can mimic various skin diseases, which means that the diagnosis of this sexually transmitted condition can be missed. Occurrence of a granulomatous inflammatory reaction in secondary syphilis is rare and may be confused with other granulomatous dermatoses.
We present a 37-year-old homosexual male with a granulomatous dermatitis due to secondary syphilis. The differential diagnosis based on clinical and histopathological findings was lengthy and the initial syphilitic serology results were negative, resulting in delayed diagnosis. After revision of the histopathology and repeated serological testing secondary syphilis could be diagnosed.
Not only the clinical, but also the histopathological presentation of secondary syphilis is variable. To prevent transmission, treatment delay and complications, we recommend repeating syphilitic serology following negative results if there is clinical or histopathological suspicion of this disease, especially in patients displaying high-risk behaviour. Syphilis should be also excluded in granulomatous dermatoses with plasma cells.
由于二期梅毒临床表现具有高度多样性，可模仿多种皮肤疾病，这意味着这种性传播疾病的诊断可能会被遗漏。二期梅毒中出现肉芽肿性炎症反应较为罕见，可能会与其他肉芽肿性皮肤病相混淆。
我们报告一名37岁的同性恋男性，因二期梅毒出现肉芽肿性皮炎。基于临床和组织病理学发现的鉴别诊断过程漫长，最初梅毒血清学结果为阴性，导致诊断延迟。经复查组织病理学并重复进行血清学检测后，得以诊断二期梅毒。
二期梅毒不仅临床表现多样，组织病理学表现也各不相同。为防止传播、治疗延误及并发症，我们建议，如果临床或组织病理学怀疑患有此病，尤其是有高危行为的患者，血清学检测结果为阴性时应重复进行梅毒血清学检测。对于有浆细胞的肉芽肿性皮肤病，也应排除梅毒。
