title: [Skin and mucosal erosions revealing secondary syphilis with otologic and eye disorders].
abstract: BACKGROUND
  The clinical polymorphism of syphilis leads to diagnostic issues. We report a case of secondary syphilis revealed by skin and mucosal erosions, and responsible for sensorineural hearing loss and asymptomatic papillitis.
  
  
  METHODS
  A 55-year-old man presented oral and peri-anal erosions as the initial symptoms of secondary syphilis. He reported hypoacusis and a pure-tone audiogram revealed bilateral sensorineural hearing loss. Ophthalmological investigation revealed isolated right papillitis and superior temporal scotoma with blind-spot enlargement. TPHA-VDRL serology was strongly positive for plasma (TPHA 1/10,240 and VDRL 1/64) but doubtful for cerebrospinal fluid. For his hearing and eye disorders, considered as related to neurosyphilis, the patient received a 14-day course of intravenous penicillin G, associated with systemic corticosteroids with gradual reduction over a period of fifteen weeks. The patient's skin and mucosal erosions resolved, as did his papillitis. His hearing loss remained stable. Serological monitoring at three months showed a sixteen-fold decrease in VDRL titre.
  
  
  CONCLUSIONS
  The re-emergence of syphilis has led to increasing incidence of related ophthalmological and otological disorders. This report highlights the first-line role of the dermatologist in systematic diagnosis and in screening for associated involvement.
authors.affiliation: Service de médecine interne, centre hospitalier de Roubaix, 11, boulevard Lacordaire, 59100 Roubaix, France. Electronic address: diane.guedes@wanadoo.fr.
authors.forename: D
authors.initials: D
authors.lastname: Guedes de Carvalho
authors.affiliation: Service d'ophtalmologie, centre hospitalier de Roubaix, 11, boulevard Lacordaire, 59100 Roubaix, France.
authors.forename: J
authors.initials: J
authors.lastname: Bouleau
authors.affiliation: Service de médecine interne, centre hospitalier de Roubaix, 11, boulevard Lacordaire, 59100 Roubaix, France.
authors.forename: M
authors.initials: M
authors.lastname: Pichenot
authors.affiliation: Service d'ophtalmologie, centre hospitalier de Roubaix, 11, boulevard Lacordaire, 59100 Roubaix, France.
authors.forename: S
authors.initials: S
authors.lastname: Dive
authors.affiliation: Service d'ophtalmologie, centre hospitalier de Roubaix, 11, boulevard Lacordaire, 59100 Roubaix, France.
authors.forename: L
authors.initials: L
authors.lastname: Duthoit
authors.affiliation: Service de médecine interne, centre hospitalier de Roubaix, 11, boulevard Lacordaire, 59100 Roubaix, France.
authors.forename: E
authors.initials: E
authors.lastname: Auxenfants
authors.affiliation: Service de médecine interne, centre hospitalier de Roubaix, 11, boulevard Lacordaire, 59100 Roubaix, France.
authors.forename: O
authors.initials: O
authors.lastname: Carpentier
mesh_terms: D001004:Anus Diseases / Q000382:microbiology*; D006319:Hearing Loss, Sensorineural / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000382:microbiology*; D010211:Papilledema / Q000382:microbiology*; D013587:Syphilis / Q000175:diagnosis*
keywords: Hearing loss; Mucosal erosion; Neurosyphilis; Papillite; Papillitis; Surdité; Syphilis; Érosion muqueuse