When Secondary Syphilis Resembles Non-Melanoma Skin Cancer: Case Study
Posted: Wednesday, November 11, 2020
Illustrating both the rise in the incidence of new cases of secondary syphilis in the United States and its varying cutaneous manifestations is a case report in Cureus describing a solitary, crusted anterior neck nodule that was initially suspected to be non-melanoma skin cancer. The 45-year-old man who tested positive for HIV had no systemic symptoms, and his history and physical exam pointed in the direction of that skin malignancy, noted Drazen Jukic, MD, PhD, of the University of Florida, Gainesville, and colleagues.
However, "histopathologic evaluation of the lesion revealed an extensive infiltrate of plasma cells at the dermoepidermal junction, and immunohistochemical staining revealed numerous Treponema pallidum microorganisms," reported the team.
The fact that the lesion turned out to be nodular secondary syphilis is markedly instructive in showing how the variations in this disease’s presentation often lead to a more difficult or delayed diagnosis, according to the authors. Secondary infection can present atypically and, especially in patients with HIV, may be readily mistaken for another dermatologic condition.
"Physicians must keep syphilis in the differential diagnosis when evaluating atypical nodular lesions resembling non-melanoma skin cancer," stressed Dr. Jukic and colleagues, particularly in the case of high-risk patients, including men who test positive for HIV. They wrote that doing so can lead to more quickly initiating appropriate antibiotic treatment to prevent future complications, including disabling tertiary manifestations and substantial morbidity.
Disclosure: No disclosure information for the authors was provided.
