Syphilis Maligna (Lues Maligna): A Case Report

Rosa Giménez-García*

Syphilis Maligna (Lues Maligna): A Case Report

Syphilis is a sexually transmitted disease produced by Treponema pallidum, an anaerobic
filamentous spirochete, which has a tropism for several organs and tissues in the body.

A rare form of detructive syphilide, with deeply ulcerative covered with thick crust lesions was
described under the name malignant syphilis Most of the cases, resulting from human immunodeficiency
virus-induced suppression of cell mediated immunity, have been reported in HIV positive patients1-20
but some cases occur in individuals with poor health, alcoholic or immunocompetent patients.

A 49-year-old promiscuous man presented to our department with multiple nodular ulcerative
lesions on his arms and legs, and a healing genital ulcer. Laboratory tests including
syphilis serology showed a Venereal Disease Research Laboratory titre of and a positive treponema
pallidum hemagglutinatoin.

HIV was positive. His CD4+ count was 425/mm³ and his HIV viral load 63,420 copies/ml.
Histopathological study of skin lesion revealed an epithelial hyperplasia, and perivascular
infiltrate containing plasma cells and endothelial thickening of blood vessels throughout
dermis extending into the subcutaneous tissue.

Early syphilis is the more contagious stage and includes the primary and secondary forms and
the early latent period. Primary syphilis is often asymptomatic and the initial lesion-chancre is
extragenital in much cases. Secondary syphilis and latent infection is the most usual forms
of presentation in HIV positive patients.

Lues maligna is a severe form of secondary syphilis. In these patients syphilis presents an
atypical clinical course with severe constitutional symptoms and unusual nodules, necrotic
or rupiod skin lesions, organ involvement and a great tendency to develop
neurosyphilis and ocular involvement.

Dermatol Open J. 2016; 1(3): 60-62. doi: 10.17140/DRMTOJ-1-116