Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Int J STD AIDS. 2020 Sep;31(10):1004-1007. doi: 10.1177/0956462420933787. Epub 2020 Jul 21.
Nodular secondary syphilis is an uncommon variant of secondary syphilis. We identified three cases of nodular secondary syphilis at our institution. The first patient presented with a diffuse nodular rash that included his scrotum and penis. The second patient had disseminated skin-colored nodules with serosanguinous crust on his face, trunk, and extremities. The third patient had a pruritic papular and nodular rash with overlying crust. All three patients had a reactive rapid plasma reagin and tested positive for fluorescent treponemal antibody absorption. All were eventually confirmed to be human immunodeficiency virus-positive. Histopathological examination demonstrated inflammatory infiltrate in the dermis composed of lymphocytes, histiocytes, and plasma cells, and treponemal staining highlighted spirochetes in the dermis. The patients were successfully treated with intramuscular penicillin benzathine G. Physicians should be aware of nodular syphilis as a less common cutaneous manifestation of secondary syphilis. Prompt diagnosis of secondary syphilis can expedite resolution of the infection and avoid progression to tertiary syphilis.
结节性二期梅毒是二期梅毒的一种罕见变异。我们在本院发现了三例结节性二期梅毒。第一例患者表现为弥漫性结节性皮疹，累及阴囊和阴茎。第二例患者面部、躯干和四肢有播散性肤色结节，伴有浆液血性结痂。第三例患者有瘙痒性丘疹和结节性皮疹，伴有结痂。这三例患者的快速血浆反应素均为阳性，荧光密螺旋体抗体吸收试验也为阳性。最终均证实为人类免疫缺陷病毒阳性。组织病理学检查显示真皮内有由淋巴细胞、组织细胞和浆细胞组成的炎症浸润，梅毒螺旋体染色在真皮内突出螺旋体。患者经肌内注射苄星青霉素 G 治疗后痊愈。医生应认识到结节性梅毒是二期梅毒较为少见的皮肤表现。及时诊断二期梅毒可加速感染的痊愈，避免进展为三期梅毒。
