Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma.
Human immunodeficiency virus-positive secondary syphilis mimicking cutaneous T-cell lymphoma.
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DOI：
10.1186/s13000-015-0419-5
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发表时间：
2015-10-08
影响因子：
2.6
通讯作者：
Yoshino T
中科院分区：
文献类型：
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作者：
Yamashita M;Fujii Y;Ozaki K;Urano Y;Iwasa M;Nakamura S;Fujii S;Abe M;Sato Y;Yoshino T
恶性梅毒或恶性梅毒是一种严重的二期梅毒，在前抗生素时代经常报告，现在随着人类免疫缺陷病毒（HIV）流行病的出现而重新出现。然而，恶性梅毒的组织病理学特征仍存在争议。本病例报告的目的是阐明艾滋病毒阳性的恶性二期梅毒的临床和组织病理学表现。一名40多岁的日本男性在过去4周内主诉发热、皮肤病变、头痛和肌痛，无淋巴结病。皮损表现为躯干、四肢、手掌和面部散在的溃疡性丘疹。虽然皮肤病变在组织学分析上被怀疑是皮肤T细胞淋巴瘤，但它们缺乏T细胞受体Jγ重排;此外，免疫组织化学分析证实了螺旋体的存在。患者接受了抗生素和抗逆转录病毒治疗，症状明显改善。根据这些皮肤病变的观察结果，我们最终诊断该患者患有与皮肤T细胞淋巴瘤相似的HIV相关二期梅毒。患者的全身CD 4+淋巴细胞计数非常低，浸润几乎完全由CD 8+非典型淋巴细胞组成;因此，该疾病容易被误诊为皮肤淋巴瘤。虽然浆细胞的丰度是皮肤组织学分析中恶性梅毒的良好指标，但在某些情况下，浆细胞计数可能非常低。因此，在诊断原发性皮肤外周T细胞淋巴瘤或与HIV感染相关的淋巴瘤之前，应考虑诊断为恶性二期梅毒。
Malignant syphilis or lues maligna is a severe form of secondary syphilis that was commonly reported in the pre-antibiotic era, and has now reemerged with the advent of the human immunodeficiency virus (HIV) epidemic. However, the characteristic histopathological findings of malignant syphilis remain controversial. The aim of this case report was to clarify the clinical and histopathological findings of HIV-positive malignant secondary syphilis. A Japanese man in his forties complained of fever, skin lesions, headache, and myalgia without lymphadenopathy during the previous 4 weeks. The skin lesions manifested as erythematous, nonhealing, ulcerated papules scattered on his trunk, extremities, palm, and face. Although the skin lesions were suspected to be cutaneous T-cell lymphomas on histological analyses, they lacked T-cell receptor Jγ rearrangement; moreover, immunohistochemical analyses confirmed the presence of spirochetes. The patient was administered antibiotics and anti-retroviral therapy, which dramatically improved the symptoms. On the basis of these observations of the skin lesions, we finally diagnosed the patient with HIV-associated secondary syphilis that mimicked cutaneous T-cell lymphoma. The patient’s systemic CD4+ lymphocyte count was very low, and the infiltrate was almost exclusively composed of CD8+ atypical lymphocytes; therefore, the condition was easily misdiagnosed as cutaneous lymphoma. Although the abundance of plasma cells is a good indicator of malignant syphilis on skin histological analyses, in some cases, the plasma cell count may be very low. Therefore, a diagnosis of malignant secondary syphilis should be considered before making a diagnosis of primary cutaneous peripheral T-cell lymphoma or lymphoma associated with HIV infection.