title: Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma.
abstract: Malignant syphilis or lues maligna is a severe form of secondary syphilis that was commonly reported in the pre-antibiotic era, and has now reemerged with the advent of the human immunodeficiency virus (HIV) epidemic. However, the characteristic histopathological findings of malignant syphilis remain controversial. The aim of this case report was to clarify the clinical and histopathological findings of HIV-positive malignant secondary syphilis. A Japanese man in his forties complained of fever, skin lesions, headache, and myalgia without lymphadenopathy during the previous 4 weeks. The skin lesions manifested as erythematous, nonhealing, ulcerated papules scattered on his trunk, extremities, palm, and face. Although the skin lesions were suspected to be cutaneous T-cell lymphomas on histological analyses, they lacked T-cell receptor Jγ rearrangement; moreover, immunohistochemical analyses confirmed the presence of spirochetes. The patient was administered antibiotics and anti-retroviral therapy, which dramatically improved the symptoms. On the basis of these observations of the skin lesions, we finally diagnosed the patient with HIV-associated secondary syphilis that mimicked cutaneous T-cell lymphoma. The patient's systemic CD4+ lymphocyte count was very low, and the infiltrate was almost exclusively composed of CD8+ atypical lymphocytes; therefore, the condition was easily misdiagnosed as cutaneous lymphoma. Although the abundance of plasma cells is a good indicator of malignant syphilis on skin histological analyses, in some cases, the plasma cell count may be very low. Therefore, a diagnosis of malignant secondary syphilis should be considered before making a diagnosis of primary cutaneous peripheral T-cell lymphoma or lymphoma associated with HIV infection.
authors.affiliation: Division of Diagnostic Pathology, Tokushima Red Cross Hospital, 103, Irinokuchi, Komatsushima-cho, Komatsushima-shi, Tokushima, 7738502, Japan. akkunrikkun@gmail.com.
authors.forename: Michiko
authors.initials: M
authors.lastname: Yamashita
authors.affiliation: Division of Diagnostic Pathology, Tokushima Red Cross Hospital, 103, Irinokuchi, Komatsushima-cho, Komatsushima-shi, Tokushima, 7738502, Japan. tn.byouri@tokushima-med.jrc.or.jp.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Fujii
authors.affiliation: Division of Hematology, Tokushima Red Cross Hospital, Tokushima, Japan. ozakei01@tokushima-med.jrc.or.jp.
authors.forename: Keiji
authors.initials: K
authors.lastname: Ozaki
authors.affiliation: Division of Dermatology, Tokushima Red Cross Hospital, Tokushima, Japan. dermis@tokushima-u.ac.jp.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Urano
authors.affiliation: Division of Hematology, Tokushima University Hospital, Tokushima, Japan. goodluck.183@hotmail.co.jp.
authors.forename: Masami
authors.initials: M
authors.lastname: Iwasa
authors.affiliation: Division of Hematology, Tokushima University Hospital, Tokushima, Japan. shingen@tokushima-u.ac.jp.
authors.forename: Shingen
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Division of Hematology, Tokushima University Hospital, Tokushima, Japan. fujii.shiro@tokushima-u.ac.jp.
authors.forename: Shiro
authors.initials: S
authors.lastname: Fujii
authors.affiliation: Division of Hematology, Tokushima University Hospital, Tokushima, Japan. masabe@tokushima-u.ac.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Abe
authors.affiliation: Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan. satou-y@okayama-u.ac.jp.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan. yoshino@md.okayama-u.ac.jp.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Yoshino
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001706:Biopsy; D060085:Coinfection; D003937:Diagnosis, Differential; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D006801:Humans; D007150:Immunohistochemistry; D016410:Lymphoma, T-Cell, Cutaneous / Q000175:diagnosis*; D008297:Male; D011237:Predictive Value of Tests; D012867:Skin / Q000382:microbiology / Q000473:pathology; D012878:Skin Neoplasms / Q000175:diagnosis*; D013587:Syphilis / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology; D013591:Syphilis, Cutaneous / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D019380:Anti-HIV Agents