Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV

Background. An estimated 25% of primary and secondary syphilis, a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum, occurs in patients coinfected with human immunodeficiency virus (HIV) (Chesson et al., 2005). This association is especially evident in men who have...

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Autores principales:	Robert Jame, Yousif Al-Saeigh, Leo L. Wang, Kevin Wang
Formato:	article
Lenguaje:	EN
Publicado:	Hindawi Limited 2021
Materias:	Infectious and parasitic diseases RC109-216
Acceso en línea:	https://doaj.org/article/a5cc2a8bc48e45cdaacba3f737507731
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spelling	oai:doaj.org-article:a5cc2a8bc48e45cdaacba3f7375077312021-11-29T00:55:30ZJustified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV2090-663310.1155/2021/1124033https://doaj.org/article/a5cc2a8bc48e45cdaacba3f7375077312021-01-01T00:00:00Zhttp://dx.doi.org/10.1155/2021/1124033https://doaj.org/toc/2090-6633Background. An estimated 25% of primary and secondary syphilis, a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum, occurs in patients coinfected with human immunodeficiency virus (HIV) (Chesson et al., 2005). This association is especially evident in men who have sex with men (MSM). In HIV-positive patients, primary syphilis infection may progress more rapidly to the tertiary, and most destructive, stage and reinfection can start with the latent or tertiary stage; in such patients, advanced syphilis may arise without clinical warning signs (Kenyan et al., 2018). It is important to note that neurosyphilis can occur during any stage of infection in all patients, regardless of immunocompetence status (CDC, 2021). Case Presentation. A 56-year-old male with a past medical history of well-controlled HIV with a CD4 count of 700 cells/mm3 and an undetectable viral load, psoriasis, and a remote episode of treated syphilis, presented with a two-week history of a diffuse desquamating rash, alopecia, sinusitis, unilateral conjunctivitis, and blurred vision. His last sexual encounter was over ten months ago. The diagnosis of syphilis was confirmed by microhemagglutination assay, and he was treated for presumed neuro-ocular infection with a two-week course of intravenous Penicillin G. Conclusion. Syphilis has acquired a reputation as “the great masquerader” due to its protean manifestations. It may follow an unpredictable course, especially in HIV-positive patients, including those whose treatment has achieved undetectable serology. For example, ocular syphilis may present in an otherwise asymptomatic individual (Rein, 2020) and alopecia may arise as the sole indication of acute syphilitic infection (Doche et al., 2017). Therefore, a high index of suspicion is warranted in order to prevent severe and irreversible complications.Robert JameYousif Al-SaeighLeo L. WangKevin WangHindawi LimitedarticleInfectious and parasitic diseasesRC109-216ENCase Reports in Infectious Diseases, Vol 2021 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Infectious and parasitic diseases RC109-216
spellingShingle	Infectious and parasitic diseases RC109-216 Robert Jame Yousif Al-Saeigh Leo L. Wang Kevin Wang Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV
description	Background. An estimated 25% of primary and secondary syphilis, a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum, occurs in patients coinfected with human immunodeficiency virus (HIV) (Chesson et al., 2005). This association is especially evident in men who have sex with men (MSM). In HIV-positive patients, primary syphilis infection may progress more rapidly to the tertiary, and most destructive, stage and reinfection can start with the latent or tertiary stage; in such patients, advanced syphilis may arise without clinical warning signs (Kenyan et al., 2018). It is important to note that neurosyphilis can occur during any stage of infection in all patients, regardless of immunocompetence status (CDC, 2021). Case Presentation. A 56-year-old male with a past medical history of well-controlled HIV with a CD4 count of 700 cells/mm3 and an undetectable viral load, psoriasis, and a remote episode of treated syphilis, presented with a two-week history of a diffuse desquamating rash, alopecia, sinusitis, unilateral conjunctivitis, and blurred vision. His last sexual encounter was over ten months ago. The diagnosis of syphilis was confirmed by microhemagglutination assay, and he was treated for presumed neuro-ocular infection with a two-week course of intravenous Penicillin G. Conclusion. Syphilis has acquired a reputation as “the great masquerader” due to its protean manifestations. It may follow an unpredictable course, especially in HIV-positive patients, including those whose treatment has achieved undetectable serology. For example, ocular syphilis may present in an otherwise asymptomatic individual (Rein, 2020) and alopecia may arise as the sole indication of acute syphilitic infection (Doche et al., 2017). Therefore, a high index of suspicion is warranted in order to prevent severe and irreversible complications.
format	article
author	Robert Jame Yousif Al-Saeigh Leo L. Wang Kevin Wang
author_facet	Robert Jame Yousif Al-Saeigh Leo L. Wang Kevin Wang
author_sort	Robert Jame
title	Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV
title_short	Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV
title_full	Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV
title_fullStr	Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV
title_full_unstemmed	Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV
title_sort	justified suspicion: symptomatic syphilitic alopecia in a patient with well-controlled hiv
publisher	Hindawi Limited
publishDate	2021
url	https://doaj.org/article/a5cc2a8bc48e45cdaacba3f737507731
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Justified Suspicion: Symptomatic Syphilitic Alopecia in a Patient with Well-Controlled HIV

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