dos Santos T R, de Castro I J, Dahia M M B, de Azevedo M C V M, da Silva G A R, Motta R N, da Cunha Pinto J, de Almeida Ferry F R
Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio De Janeiro, RJ, Brazil.
Infection. 2015 Apr;43(2):231-6. doi: 10.1007/s15010-014-0698-x. Epub 2014 Nov 19.
Malignant syphilis is an uncommon, but not unknown, ulcerative variation of secondary syphilis. The lesions typically begin as papules, which quickly evolve to pustules and then to ulcers with elevated edges and central necrosis. It is usually, but not mandatory, found in patients with some level of immunosuppression, such as HIV patients, when the TCD4(+) cell count is >200 cells/mm(3). Despite the anxiety the lesions cause, this form of the disease has a good prognosis. The general symptoms disappear right after the beginning of treatment, and lesions disappear over a variable period. This study reports the case of a 27-year-old man who has been HIV positive for 6 years, uses antiretroviral therapy incorrectly, has a TCD4(+) cell count of 340 cells/mm(3), a VDRL of 1:128 and itchy disseminated hyperchromic maculopapular lesions with rupioid crusts compatible with malignant syphilis.
恶性梅毒是二期梅毒一种不常见但并非不为人知的溃疡性变体。病变通常始于丘疹，迅速发展为脓疱，然后发展为边缘隆起、中央坏死的溃疡。它通常（但并非必然）见于有一定程度免疫抑制的患者，如HIV患者，此时TCD4(+)细胞计数>200个细胞/mm³。尽管这些病变会引起焦虑，但这种疾病形式预后良好。一般症状在治疗开始后随即消失，病变会在一段可变的时间内消退。本研究报告了一名27岁男性的病例，该男性HIV阳性6年，抗逆转录病毒治疗使用不当，TCD4(+)细胞计数为340个细胞/mm³，VDRL为1:128，有瘙痒性播散性色素沉着过度性斑丘疹伴蛎壳状痂皮，符合恶性梅毒。
