Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2019; 7(16): 2406-2412
Published online Aug 26, 2019. doi: 10.12998/wjcc.v7.i16.2406
Malignant syphilis accompanied with neurosyphilis in a malnourished patient: A case report
Gai Ge, Dong-Mei Li, Ying Qiu, Hong-Jun Fu, Xiang-Yu Zhang, Dong-Mei Shi
Gai Ge, Jining Medical University, Jining 272067, Shandong Province, China
Dong-Mei Li, Georgetown University Medical Center, Washington, DC 20057, United States
Ying Qiu, Hong-Jun Fu, Department of Dermatology, Jining No. 1 People’s Hospital, Jining 272067, Shandong Province, China
Xiang-Yu Zhang, Department of Pathology, Jining No. 1 People’s Hospital, Jining 272067, Shandong Province, China
Dong-Mei Shi, Department of Dermatology and Laboratory of Medical Mycology, Jining No. 1 People’s Hospital, Jining 272067, Shandong Province, China
Author contributions: Shi DM designed the case report; Ge G, Shi DM, and Li DM analyzed all the data and wrote the manuscript; Qiu Y, Fu HJ, and Zhang XY collected the information; Li DM made some modifications to the manuscript. All authors read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81773337; the Shandong Traditional Chinese Medicine Science and Technology Development Plans, China, No. 2017-415; the Medical and Health Science Technology Project of Shandong Province, China, No. 2017WS345; and the Natural Science Foundation of Shandong Province, China, No. ZR2015HL127.
Informed consent statement: Institutional ethics review board at Jining No. 1 People’s Hospital approved this study. The patient gave written consent for the publication of the figures as well as this case report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Dong-Mei Shi, MD, PhD, Doctor, Department of Dermatology and Laboratory of Medical Mycology, Jining No. 1 People's Hospital, No. 6, Jiankang Road, Jining 272067, Shandong Province, China. shidongmei28@163.com
Telephone: +86-537-6050108 Fax: +86-537-2256374
Received: March 25, 2019
Peer-review started: March 26, 2019
First decision: May 31, 2019
Revised: July 9, 2019
Accepted: July 20, 2019
Article in press: July 20, 2019
Published online: August 26, 2019
Processing time: 155 Days and 10.9 Hours
Abstract
BACKGROUND

Syphilis is a common sexually transmitted disease caused by the Treponema pallidum (T. pallidum). Malignant syphilis is a rare presentation of secondary syphilis. Here, we present a case diagnosed with malignant syphilis accompanied with neurosyphilis.

CASE SUMMARY

A 56-year-old man present with a 2-mo history of spreading ulcerous and necrotic papules and nodules covered with thick crusts over the face, trunk, extremities, and genitalia. The patient was diagnosed with malignant syphilis accompanied by neurosyphilis based on the characteristic morphology of the lesions, positive serological and cerebrospinal fluid tests for syphilis, brain magnetic resonance imaging, and histopathology, along with resolution of the lesions following the institution of penicillin therapy. The lesions and neurological condition successfully resolved after a course of treatment with penicillin.

CONCLUSION

We suggest that neurosyphilis should be considered whenever people have psychiatric symptoms without cutaneous lesions or human immunodeficiency virus.

Keywords: Malignant syphilis; Secondary syphilis; Neurosyphilis; Jarisch-Herxheimer reaction; Case report

Core tip: We present a 53-year-old malnourished man with a two-month history of spreading ulcerative and necrotic cutaneous lesions with psychiatric symptoms. The patient was diagnosed with malignant syphilis accompanied by neurosyphilis based on the characteristic morphology, positive serological and cerebrospinal fluid tests, and histopathology, with resolution of the lesions following penicillin therapy. We report the case to emphasize the diagnosis of the disease, and its association not only with human immunodeficiency virus (HIV), but also with other poor health conditions, specifically malnutrition. We suggest that neurosyphilis should be considered whenever people have psychiatric symptoms even in case of no cutaneous lesions or HIV infection.