Introduction

The course of syphilis implies a change in the periods of the disease development [1], which is characterized by its own clinical picture, indications of serological tests, and degree of epidemic danger [2]. The early periods of syphilis are characterized by specific clinical manifestations [3], well known to practitioners, however polymorphism of clinical manifestations can become a source of diagnostic mistakes [4]. In patients with a history of chronic dermatoses, manifestations of syphilis can mimic the stage of exacerbation of dermatosis [5]. Diagnostics in such patients should be comprehensive and include the collection of anamnestic data confirming the presence of chronic dermatosis, collection of a sexual history, examination of sexual contacts, the results of serological tests and information about treatment effect [6]. Laboratory and clinical examination allows doctor to suggest the specific nature of the lesion [7].

The purpose of this work is to pay the doctors’ attention to the manifestations of clinical polymorphism in case of secondary syphilis’ period; especially in patients suffering from chronic skin diseases.

Here is an observation

Patient M., born in 1992, applied to the Moscow Scientific Center for Dermatology, Venereology and Cosmetology in January 2019 with complaints of itchy rashes on the trunk and extremities skin that arose 1.5 months ago for no apparent reason. There was a history of chronic eczema; the last exacerbation happened about one year ago. In childhood — atopic dermatitis; it does not appear from the age of 15; HIV infection since 2016.

Discharge report on «chronic eczema; exacerbation stage» from dermatologist of a private medical center is presented. On this occasion, the following treatment was carried out: a solution of diprospan 2 ml intramuscularly one time, antihistamines, desensitizing drugs, topical corticosteroid ointment. No positive dynamics was observed from such treatment. The patient was referred to the specialized medical care of Moscow Scientific Center for Dermatology, Venereology and Cosmetology for consultation, diagnosis clarification and management tactics.

At the time of examination, the skin process is symmetrically widespread with acute inflammatory signs. On the skin of the trunk and extremities the erythematous-squamous confluent foci with serous scales on the surface are determined. Dermographism is red (Fig. 1). The genitals are developed correctly in the male pattern; the inguinal lymph nodes are not enlarged. There is no discharge from the urethra, the external opening of the urethra and the perianal region is normal. The scalp is preserved, the hair is not damaged. The mucous membrane of the oral cavity is free from rashes.

Fig 1. Patient M. before starting antibiotic therapy.

Taking into account the data of the anamnesis, the results of the clinical examination, the diagnosis was assumed: eczema? It was recommended the hospitalization in the inpatient department of Clinic branch V.G. Korolenko for further examination, clarification of diagnosis and treatment.

At the pre-hospital stage, a screening study for syphilis was performed.

Research results: 01/11/2019 RMP (reaction of micro-precipitation) 4+ 1/64, RPHA (reaction of passive hem-agglutination) 4+ 1/655360, IFA (immuno-fluorescence assay) for IgM neg., IgG positive. k / n 9.4. When examining scrapings for fungal infection, pathogenic fungi were not found. In clinical and biochemical blood tests, no deviations from the norm were found.

From the anamnesis of the disease: in October 2017, the patient was treated for early latent syphilis in a private medical center; he was not undergoing clinical and serological control. Independently in August 2018 he donated blood on serologic reaction: RMP neg., RPHA 1/2560, IFA IgM neg., IgG positive. k / n 2.57. Not married, no permanent sexual partner. He notes periodic sexual intercourse with unfamiliar women. Contacts are not always protected by a condom.

It was recommended to conduct a liquor study to deregister the syphilis at the special Center which patient refused. Patient was prescribed the specific treatment with ceftriaxone, 1 ml 1 time per day intramuscularly, every day, 20 days.

After the 1st injection, he noted an increase in body temperature up to 38.10C, chills. While the anti-syphilitic treatment with ceftriaxone, the skin process resolved to spots of secondary hyperpigmentation (Fig. 2), the itching stopped.

Fig 2. Patient M. after the end of the course of antibiotic therapy.

Conclusion

The paper presents a case of secondary syphilis of the skin and mucous membranes in an HIV-infected patient with atopic dermatitis and chronic eczema with clinical initiation as eczema-like syphilis, which is a rare phenomenon and in this situation led to an untimely diagnosis of a specific process in a patient with chronic dermatosis.