Gabrielli Chiara, Cardaci Salvatore, Malincarne Lisa, Pasticci Maria Bruna
Infectious Disease Clinic, Department of Medicine, University of Perugia, Perugia, Italy.
SAGE Open Med Case Rep. 2018 Mar 28;6:2050313X18767229. doi: 10.1177/2050313X18767229. eCollection 2018.
A 37-year-old Caucasian male, HIV-infected (CDC A2) in 2012 and on antiretroviral therapy, presented for a follow-up visit. On physical examination, a barely discernible light-colored macular rash was observed on the trunk, not involving the palms and soles. However, clear maculo-papular lesions were present over the proximal volar aspect of both forearms. Furthermore, well-demarked purplish, opaque, rough, vertically ridged plaque-like lesions were observed over the proximal portions of fingernails. The patient reported that cutaneous and nail lesions had appeared about 2 months prior and that he had engaged in unprotected sex 5 months before. Serologic tests for syphilis resulted reactive. Intramuscular injection of benzathine penicillin G, 2.4 million units, was administered once a week for 3 weeks. One month after therapy, the rash was no longer present, and at 5 months, nail abnormalities had disappeared. The clinical findings, the serologic results, and the disappearance of skin and nail lesions after the administration of penicillin strongly suggest that this HIV-infected patient had secondary or early late syphilis with skin and nail-plate involvement. We are experiencing a resurgence of syphilis as well as an increase in unusual and/or forgotten clinical manifestations. Syphilis remains a diagnostically challenging disease.
一名37岁的白人男性，2012年感染HIV（疾病控制与预防中心A2期）并接受抗逆转录病毒治疗，前来进行随访。体格检查发现，躯干上有一处几乎难以察觉的浅色斑疹，手掌和脚底未累及。然而，双侧前臂近端掌侧有明显的斑丘疹病变。此外，在指甲近端可见界限清晰的紫色、不透明、粗糙、有垂直嵴的斑块样病变。患者报告说，皮肤和指甲病变大约在2个月前出现，他在5个月前有过无保护性行为。梅毒血清学检测呈阳性。肌肉注射苄星青霉素G，240万单位，每周一次，共3周。治疗1个月后，皮疹消失，5个月时，指甲异常也消失了。临床发现、血清学结果以及青霉素治疗后皮肤和指甲病变的消失强烈提示，这名HIV感染患者患有二期或早期晚期梅毒，累及皮肤和甲板。我们正在经历梅毒的复发以及不寻常和/或被遗忘的临床表现的增加。梅毒仍然是一种诊断具有挑战性的疾病。
