[Syphilis in the context of HIV-infection--a complex disease].
METHODS
A 39-year-old man complained about a slightly reddish non-itching rash evolving on his body during the last few weeks without any general symptoms. Physical examination revealed trunk-dominated roseola, papules, a few nodules with haemorrhagic crust on top, and round hyperkeratotic clavus-like lesion on the left plantar foot. In his mouth, he had a few up to 1.5 cm large erosions, and on his capillitium a diffuse alopecia.


METHODS
Serologic testing for syphilis was positive with Treponema-pallidum-particle-agglutination test at 1:163840, VDRL 1:64, positive IgG-FTA-ABS and 19S-IgM-FTA-ABS tests, and a pleocytosis of the liquor. In addition, there were a co-infection with mycoplasma hominis and first diagnosis of HIV infection (CDC-stadium A1).


METHODS
The patient was diagnosed as having secondary syphilis with suspicion of neurologic involvement and was therefore treated with 6x5 Mio. I.E. Penicillin G i.v. per day for 14 days after the initial application of 40 mg methylprednisolone. Under this regimen complete resolution of the skin lesions was noted over a 4 week period as well as slow re-growth of the hair. HIV infection at stadium A1 did not require antiretroviral treatment.


CONCLUSIONS
A non-pruritic rash should always point to the differential diagnosis of syphilis. If syphilis is diagnosed, any other sexually transmitted disease including HIV should be excluded as possible co-infection. In case of HIV, neurosyphilis can develop at an earlier stage of common syphilis.
Niedermeier
A
A
Klinik und Poliklinik für Dermatologie und Allergologie der Ludwig-Maximilians Universität München.
Kovnerystyy
O
O
Braun-Falco
M
M
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006679:HIV Seropositivity / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009460:Neurologic Examination; D009494:Neurosyphilis / Q000175:diagnosis* / Q000188:drug therapy; D010348:Patient Care Team; D010400:Penicillin G / Q000627:therapeutic use; D015231:Sexually Transmitted Diseases, Bacterial / Q000175:diagnosis* / Q000188:drug therapy; D013588:Syphilis Serodiagnosis; D013591:Syphilis, Cutaneous / Q000175:diagnosis* / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D010400:Penicillin G; D008775:Methylprednisolone