Malignant Syphilis as the Onset of Human Immunodeficiency Virus Infection in an Adult Patient at the Hipólito Unanue Hospital in Tacna, 2024
DOI:
https://doi.org/10.70409/rmhhut.v18i3.131Keywords:
syphilis, sexually transmitted infectionAbstract
Syphilis is a sexually transmitted infection (STI) caused by the spirochete Treponema pallidum. HIV infection can modulate the clinical presentation of syphilis, as well as the clinical and serological response to treatment. Syphilis can also negatively impact HIV viral load. In 2022, 207 255 cases of syphilis at all stages were reported. There is a high rate of HIV coinfection among men who have sex with men (MSM) with syphilis (7-12). Available data from the US Centers for Disease Control and Prevention (CDC) suggest that approximately 41.7% of MSM with primary and secondary syphilis have HIV, compared to nearly 6.3% of men who have sex with women and 4% of women (13). Malignant syphilis (MS) is a rare manifestation of secondary syphilis (ulceronodular syphilis) and is a
severe cutaneous form of syphilis. Although rare, defective cellular immunity plays an important role in the pathogenesis of malignant syphilis (41) as described in patients with HIV (31,37-40). In this article, we present the clinical case of a 20-yearold female patient with no prior medical history who was admitted to the emergency department with a 63-day history of illness. She presented with an unquantified fever, papulonodular skin lesions all over her body, predominantly on her face, nasal pyramid, palms, and soles, and a 10-kilogram weight loss over two months. RPR serological tests were performed, with positive results, as were third- and fourth-generation rapid HIV tests. The patient began treatment with sodium penicillin G for syphilis and oxacillin for a superimposed
pyogenic skin infection. She showed a favorable clinical course, with a reduction and healing of the skin lesions. Subsequently, antiretroviral therapy (ART) was initiated with tenofovir, lamivudine, and dolutegravir (TLD). The patient tolerated the antiretroviral treatment, achieving undetectable viral load levels six months after starting ART.
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