title: A nodular-ulcerative form of secondary syphilis in AIDS.
abstract: An uncommon variant in the pre-AIDS era, lues maligna is a nodular-ulcerative form of secondary syphilis. We present a case of a 41-year-old man with HIV infection who developed fever, chills, nausea, vomiting, right upper quadrant abdominal pain, weight loss, watery diarrhea, and a painless, nonpruritic rash. He had diffuse nodular-ulcerative lesions in various stages of development. He was found to have a CD4 count of 101 cells/mm3(22%), an HIV viral load of 2,735,060 copies/mL, and a positive rapid plasma reagin at 1:64. He was started on emtricitabine, tenofovir, and dolutegravir, as well as doxycycline. He was given benzathine penicillin 2.4 million units intramuscularly and within hours developed a Jarisch-Herxheimer reaction. Skin lesions showed signs of healing, and constitutional symptoms improved 48 hours later.
authors.affiliation: Department of Medicine, Section of Infectious Diseases, Presence Saint Joseph Hospital, Chicago, Illinois.
authors.forename: Ofelya
authors.initials: O
authors.lastname: Gevorgyan
authors.affiliation: Department of Medicine, Section of Infectious Diseases, Presence Saint Joseph Hospital, Chicago, Illinois.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Owen
authors.affiliation: Department of Medicine, Section of Infectious Diseases, Presence Saint Joseph Hospital, Chicago, Illinois.
authors.forename: Arvind
authors.initials: A
authors.lastname: Balavenkataraman
authors.affiliation: Department of Medicine, Section of Infectious Diseases, Presence Saint Joseph Hospital, Chicago, Illinois.
authors.forename: Mitchell R
authors.initials: MR
authors.lastname: Weinstein