Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-11T01:48:09.580Z Has data issue: false hasContentIssue false
  • English
  • Français

A rare case of a chronic syphilitic gumma in a man infected with human immunodeficiency virus

Published online by Cambridge University Press:  09 June 2014

S D Masege  and
A Karstaedt
S D Masege*
Affiliation:
Ear, Nose and Throat Department/Head and Neck Surgery, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Soweto, Johannesburg, South Africa
A Karstaedt
Affiliation:
Department of Medicine (Division of Infectious Diseases), Chris Hani Baragwanath Hospital and University of the Witwatersrand, Soweto, Johannesburg, South Africa
*
Address for correspondence: Dr S D Masege, Ear, Nose and Throat Department/ Head and Neck Surgery, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Soweto, Johannesburg, South Africa E-mail: masege@surgeon.co.za
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

This paper reports a rare case of a human immunodeficiency virus infected man with gummatous syphilis of the face.

Case report:

A 39-year-old man presented with an ulcer of the face which had been slowly progressive over the previous 6 years. Examination showed an ulcerative lesion of the midface involving the cheeks, and completely destroying the nose, the upper lip and part of the lower lip. The teeth and gums were exposed. The ulcer had a moist, purulent base with rolled edges. The patient had human immunodeficiency virus, with a cluster of differentiation 4 count of 641 cells per µl. The rapid plasma reagin test titre was 1:1024 and the Treponema pallidum haemagglutination assay result was positive. Biopsy showed non-necrotising granulomata with a negative Warthin–Starry silver stain. There was a dramatic response to treatment with penicillin.

Conclusion:

This case study is a reminder that syphilis needs to be considered in the differential diagnosis of unusual presentations involving skin and bone.

Keywords

SyphilisNeurosyphilis, GummatousHIVPenicillinPathologyFace
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 6 , June 2014 , pp. 557 - 560
Copyright
Copyright © JLO (1984) Limited 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Zetola, NM, Klausner, JD. Syphilis and HIV infection: an update. Clin Infect Dis 2007;44:1222–8CrossRefGoogle ScholarPubMed
2Dawson, S, Evans, BA, Lawrence, AG. Benign tertiary syphilis and HIV infection. AIDS 1988;2:315–16Google Scholar
3Hay, PE, Tam, FWK, Kitchen, VS, Horner, S, Bridger, J, Weber, J. Gummatous lesions in men infected with human immunodeficiency virus and syphilis. Genitourin Med 1990;66:374–9Google Scholar
4Lynn, WA, Lightman, S. Syphilis and HIV: a dangerous combination. Lancet Infect Dis 2004;4:456–66Google Scholar
5Harrison, LW. The Oslo study of untreated syphilis review and commentary. Br J Vener Dis 1956;32:70–8Google Scholar
6Rockwell, DH, Yobs, AR, Moore, MB Jr.The Tuskegee study of untreated syphilis: the 30th year of observation. Arch Intern Med 1964;114:792–8CrossRefGoogle ScholarPubMed
7Nnoruka, EN, Ezeoke, AC. Evaluation of syphilis in patients with HIV infection in Nigeria. Trop Med Int Health 2005;10:58–64Google Scholar
8Hicks, CB, Benson, PM, Lupton, GP, Tramont, EC. Seronegative secondary syphilis in a patient infected with the human immunodeficiency virus (HIV) with Kaposi sarcoma. A diagnostic dilemma. Ann Intern Med 1987;107:492–5CrossRefGoogle Scholar
9Taniguchi, S, Osato, K, Hamada, T. The prozone phenomenon in secondary syphilis. Acta Derm Venereol 1995;75:153–4Google Scholar
10Rodriguez, S, Teich, DL, Weinman, MD, Greene, JM, Keroack, MA, Apstein, MD. Gummatous syphilis: a reminder. J Infect Dis 1988;157:606–7CrossRefGoogle ScholarPubMed
11Fargen, KM, Alvernia, JE, Lin, CS, Melgar, M. Cerebral syphilitic gummata: a case presentation and analysis of 156 reported cases. Neurosurgery 2009;64:568–76Google Scholar