The Great Imitator Meets Pruritic Papular Eruption: A Case of Secondary Syphilis and HIV Co-Infection
DOI:
https://doi.org/10.37287/ijghr.v8i5.2379Keywords:
co-infection, great imitator, HIV, pruritic papular eruption, secondary syphilis, systemic corticosteroidsAbstract
Secondary syphilis, notoriously known as "the great imitator," can present with highly atypical cutaneous manifestations, particularly in immunocompromised individuals. In patients with human immunodeficiency virus (HIV) co-infection, distinguishing secondary syphilis from HIV-associated dermatoses, such as pruritic papular eruption (PPE), poses a significant diagnostic challenge. This report aims to describe an atypical case of secondary syphilis mimicking PPE in a newly diagnosed HIV patient, to highlight the diagnostic complexities and the potential risks of inappropriate empiric systemic corticosteroid therapy. A 26-year-old male presented with a one-month history of a generalized, intensely pruritic, and crusted papular rash. His condition rapidly disseminated and worsened following empiric treatment with systemic corticosteroids by a general practitioner. Dermatological examination revealed generalized, well-demarcated erythematous papules with overlying crusts and fine scales, closely mimicking PPE. The patient reported a history of high-risk sexual behavior. Serological testing confirmed active secondary syphilis (VDRL 1:64, TPHA reactive) and revealed a previously undiagnosed HIV infection. The patient was successfully treated with a single dose of intramuscular benzathine penicillin G (2.4 million IU) and topical therapy comprising desoximetasone 0.25% and gentamicin 0.1% creams, alongside an immediate referral for antiretroviral therapy (ART). This case highlights the clinical overlap between atypical secondary syphilis and PPE in HIV-positive patients. It strongly underscores the critical need for comprehensive sexually transmitted infection (STI) screening prior to initiating systemic immunosuppressive therapy for generalized eruptions, especially in high-risk populations.
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