Multiple skin ulcers from malignant syphilis

摘要: A 38-year-old man presented to our department in April, 2014, with a 1 month history of multiple painful skin ulcers (fi gure) on his face, trunk, and extremities. The eruptions had started as papular nodular lesions progressed pustules within 2 weeks. He been diagnosed pyoderma gangrenosum at local hospital treated methylprednisolone. After week, the worsened he developed fever. reported having sex four women during past year denied ever men. Histological examination biopsy sample from an ulcer left arm indicated psoriasiform epidermal hyperplasia central ulceration. In dermis we noted mixed perivascular infi ltrate neutrophils, lymphocytes, plasma cells, histiocytes. Stains for fungi, mycobacteria, spirochetes were negative. Full blood cell count, CD4 CD8 anti-neutrophil cytoplasm antibody test, HIV serotest, cultures fungi bacteria (including Mycobacterium tuberculosis Neisseria gonorrhoeae) normal or erythrocyte sedimentation rate (ESR) was 50 mm/h (normal range 0–20 mm/h). Serum treponema pallidum particle agglutination assay (TPPA) positive rapid reagin (RPR) titre 1:128. On basis clinical examination, serum TPPA, RPR, histological malignant syphilis. We 2·4 mg intramuscular benzathine penicillin injections, once week 3 6 months later healed completely, although atrophic scars remained gure); RPR titer dropped 1:1 serotest Malignant syphilis is rare form destructive secondary It usually occurs weeks after primary infection, earlier people HIV. Syphilis common sexually transmitted disease China, incidence 0·03% 2014. However, rare.