title: [Cutaneous manifestation of late-type syphilis].
abstract: METHODS
  A 49-year-old, otherwise healthy man presented at his dermatologist with tuberous skin changes that had be present for several weeks on head, arm and leg. These were asymptomatic, but disturbed him cosmetically. A skin biopsy was performed.
  
  
  METHODS
  The skin biopsy showed a granulomatous inflammation with prominent plasma cells, consistent with granulomatous infiltrate. Serologic tests confirmed a Treponema pallidum-infection. In addition, the patient was tested positive for hepatitis C and HIV (CDC stage A1). The clinical neurological examination did not show any pathological findings, however, analysis of the cerebrospinal fluid revealed a mild pleocytosis, elevation of protein and the glucose quotient and a normal Treponema pallidum TPPA-antibody index. A mesaortitis was excluded.
  
  
  RESULTS
  We diagnosed a tertiary syphilis (stage III). The patient refused prolonged inpatient treatment with penicillin G i.v., as recommended as first-line therapy in the national guidelines for asymptomatic neurosyphilis. Therefore, after a single oral administration of 100 mg prednisolone he received ceftriaxone intravenously for 14 days. The skin changes resolved. With regard to the HIV infection anti-retro-viral therapy was not yet indicated.
  
  
  CONCLUSIONS
  In view of the increasing incidence of syphilis in Germany clinicians should consider this diagnosis when confronted with oligosymptomatic skin lesions.
authors.affiliation: Klinik für Hautkrankheiten des Universitätsklinikums Jena.
authors.forename: C
authors.initials: C
authors.lastname: Schummer
authors.affiliation: Klinik für Hautkrankheiten des Universitätsklinikums Jena.
authors.forename: S
authors.initials: S
authors.lastname: Schliemann
authors.affiliation: Praxis für Dermatologie, Jena.
authors.forename: V
authors.initials: V
authors.lastname: Fünfstück
authors.affiliation: Klinik für Hautkrankheiten des Universitätsklinikums Jena.
authors.forename: P
authors.initials: P
authors.lastname: Elsner
mesh_terms: D000284:Administration, Oral; D001706:Biopsy; D002443:Ceftriaxone / Q000008:administration & dosage; D015897:Comorbidity; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D006679:HIV Seropositivity / Q000175:diagnosis / Q000473:pathology; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009494:Neurosyphilis / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D011239:Prednisolone / Q000008:administration & dosage; D012867:Skin / Q000473:pathology; D013587:Syphilis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D013588:Syphilis Serodiagnosis; D013591:Syphilis, Cutaneous / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology
chemical_list: D002443:Ceftriaxone; D011239:Prednisolone