title: Lues maligna praecox: an important consideration in HIV-positive patients with ulceronodular skin lesions.
abstract: Syphilis is commonly known as "the great imitator" owing to its varied clinical manifestations. Secondary syphilis has a variety of presentations, with the most common manifesting as a diffuse papulosquamous eruption on the palms and soles. Lues maligna praecox is a rare form of secondary syphilis, with severe constitutional symptoms, seen primarily in HIV-positive individuals. We report an atypical case of suspected lues maligna in a 45-year-old male. The patient was HIV-positive with a CD4 count of 441. He presented to our clinic with large painful gummatous ulcers in the groin and lower back. He also reported daily fevers, night sweats, and weight loss consistent with secondary syphilis. Prior to this episode the patient had a history of acute active syphilis (RPR 1:128) in 2012 treated at that time with a single dose of 2.4 million units intramuscular benzathine penicillin; he had no reported exposures since that time. The patient was treated with three weekly doses of benzathine penicillin, 2.4 million units, given intramuscularly. This case demonstrates the importance of recognizing the varied clinical presentation of secondary syphilis and keeping lues maligna in consideration for ulceronodular skin lesions in patients who are HIV-positive.
authors.affiliation: University of Kansas Medical Center - Department of Dermatology.
authors.forename: Cody
authors.initials: C
authors.lastname: Hanson
authors.forename: Ryan
authors.initials: R
authors.lastname: Fischer
authors.forename: Garth
authors.initials: G
authors.lastname: Fraga
authors.forename: Anand
authors.initials: A
authors.lastname: Rajpara
authors.forename: Daniel
authors.initials: D
authors.lastname: Hinthorn
authors.forename: Daniel
authors.initials: D
authors.lastname: Aires
authors.forename: Deede
authors.initials: D
authors.lastname: Liu
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001415:Back / Q000473:pathology; D018791:CD4 Lymphocyte Count; D006119:Groin / Q000473:pathology; D006679:HIV Seropositivity; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D010401:Penicillin G Benzathine / Q000627:therapeutic use; D012883:Skin Ulcer / Q000382:microbiology / Q000473:pathology; D013587:Syphilis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D010401:Penicillin G Benzathine