Liu Hongfang, Goh Beng-Tin, Huang Taoyuan, Liu Yinghui, Xue Ruzeng, Ke Wujian, Gu Mei, Yang Bin
1 Dermatology Hospital of Southern Medical University (Guangdong Provincial Dermatology Hospital), Guangzhou, China.
2 Ambrose King Centre, Royal London Hospital, London, UK.
Int J STD AIDS. 2019 Mar;30(3):304-309. doi: 10.1177/0956462418805197. Epub 2018 Nov 27.
Early syphilis can rarely cause erythema multiforme-type eruptions as well as triggering erythema multiforme (EM). EM-like lesions in secondary syphilis are characterized by clinical features of EM and laboratory tests consistent with secondary syphilis and the skin histology shows predominantly a plasma cell infiltrate with the presence of treponemes. When EM is triggered by early syphilis, the skin histology shows mixed inflammatory cells usually in the absence of treponemes in the skin lesion. There may also be mixed histology with the presence of treponemes in the absence of a plasma cell infiltrate and vice versa. We describe a case of secondary syphilis presenting as EM with bullae and histology showing EM features without a plasma cell infiltrate but positive for Treponema pallidum by immunohistochemical staining. The patient was also coinfected with cytomegalovirus, human immunodeficiency virus, and anal warts. The EM eruptions resolved with treatment for secondary syphilis with benzathine penicillin G.
早期梅毒极少会引发多形红斑型皮疹以及触发多形红斑（EM）。二期梅毒中的类多形红斑损害的特征为具有多形红斑的临床特点以及与二期梅毒相符的实验室检查结果，且皮肤组织学检查主要显示为浆细胞浸润并存在梅毒螺旋体。当多形红斑由早期梅毒触发时，皮肤组织学检查显示通常为混合性炎性细胞，皮肤损害中通常不存在梅毒螺旋体。也可能存在混合性组织学表现，即存在梅毒螺旋体但无浆细胞浸润，反之亦然。我们报告一例二期梅毒病例，表现为伴有大疱的多形红斑，组织学检查显示有多形红斑特征但无浆细胞浸润，但免疫组化染色显示苍白密螺旋体呈阳性。该患者还合并感染了巨细胞病毒、人类免疫缺陷病毒以及肛周湿疣。经苄星青霉素G治疗二期梅毒后，多形红斑皮疹消退。
