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Syphilis, the Great Imitator—Clinical and Dermoscopic Features of a Rare Presentation of Secondary Syphilis

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Listed:
  • Carmen Cantisani

    (Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy)

  • Federica Rega

    (Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy)

  • Luca Ambrosio

    (Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy)

  • Teresa Grieco

    (Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy)

  • Norbert Kiss

    (Department of Dermatology, Venereoslogy and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary)

  • Fanni Adél Meznerics

    (Department of Dermatology, Venereoslogy and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary)

  • András Bánvölgyi

    (Department of Dermatology, Venereoslogy and Dermatooncology, Semmelweis University, H-1085 Budapest, Hungary)

  • Giordano Vespasiani

    (Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy)

  • Francesca Arienzo

    (Department of Radiological, Oncological and Pathological Sciences, “Sapienza Medical School” University of Rome, 00161 Rome, Italy)

  • Giovanni Rossi

    (Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy)

  • Giuseppe Soda

    (Department of Radiological, Oncological and Pathological Sciences, “Sapienza Medical School” University of Rome, 00161 Rome, Italy)

  • Giovanni Pellacani

    (Dermatology Unit, Department of Clinical Internal Anesthesiologic Cardiovascular Sciences, “Sapienza Medical School” University of Rome, 00185 Rome, Italy)

Abstract

Syphilis is characterized by a wide range of variable clinical symptoms; therefore, it is often referred to as “The Great Imitator”. Here, we report the case of a 69-year-old hepatitis-C-positive MSM patient, who was admitted to our clinic due to a solitary firm painless erythematous maculopapular lesion with a central crater-like crust on the upper right thigh that occurred two months prior. The dermoscopy showed an erythematous, copper-colored, oval lesion with diffuse monomorphic dotted and glomerular vessels, central crust, and circular scaling (Biett’s sign). The histological findings ruled out neoplasia and described a plasma cell infiltrate and endothelial swelling. Finally, the combination of the dermoscopic image, histological findings and the additionally acquired knowledge about the sexual history of the patient at the second visit led to the diagnosis, which was then confirmed with serological tests. Dermoscopy may become a supportive tool to facilitate the recognition of secondary syphilis; however, the reporting of these atypical cases is crucial to highlight the many faces of the disease so that clinicians consider syphilis as part of the differential diagnosis of non-specific lesions.

Suggested Citation

  • Carmen Cantisani & Federica Rega & Luca Ambrosio & Teresa Grieco & Norbert Kiss & Fanni Adél Meznerics & András Bánvölgyi & Giordano Vespasiani & Francesca Arienzo & Giovanni Rossi & Giuseppe Soda & G, 2023. "Syphilis, the Great Imitator—Clinical and Dermoscopic Features of a Rare Presentation of Secondary Syphilis," IJERPH, MDPI, vol. 20(2), pages 1-10, January.
    • Handle: RePEc:gam:jijerp:v:20:y:2023:i:2:p:1339-:d:1032438
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    References listed on IDEAS

    as
    1. Antal Jobbágy & Norbert Kiss & Fanni Adél Meznerics & Klára Farkas & Dóra Plázár & Szabolcs Bozsányi & Luca Fésűs & Áron Bartha & Endre Szabó & Kende Lőrincz & Miklós Sárdy & Norbert Miklós Wikonkál &, 2022. "Emergency Use and Efficacy of an Asynchronous Teledermatology System as a Novel Tool for Early Diagnosis of Skin Cancer during the First Wave of COVID-19 Pandemic," IJERPH, MDPI, vol. 19(5), pages 1-14, February.
    2. Kende Lőrincz & Fanni Adél Meznerics & Antal Jobbágy & Norbert Kiss & Mária Madarász & Laura Belvon & Béla Tóth & Béla Tamási & Norbert Miklós Wikonkál & Márta Marschalkó & András Bánvölgyi, 2022. "STIs during the COVID-19 Pandemic in Hungary: Gonorrhea as a Potential Indicator of Sexual Behavior," IJERPH, MDPI, vol. 19(15), pages 1-7, August.
    3. Cohen, S.E. & Ng, R.A.C. & Katz, K.A. & Bernstein, K.T. & Samuel, M.C. & Kerndt, P.R. & Bolan, G., 2012. "Repeat syphilis among men who have sex with men in California 2002-2006: Implications for syphilis elimination efforts," American Journal of Public Health, American Public Health Association, vol. 102(1), pages 1-8.
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