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A case of Syphilitic Gumma : Extremely rare type of Tertiary syphilis


A case of Syphilitic Gumma :  Extremely rare type of Tertiary syphilis

A case of Syphilitic Gumma an extremely rare type of Tertiary syphilis has been published in the Annals of Dermatology. Dr Jungyoon Moon at Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea and colleagues have reported the case.

Syphilis is transmitted from person to person by direct contact with a syphilitic sore, known as a chancre. The average time between the acquisition of syphilis and the start of the first symptom is 21 days but can range from 10 to 90 days. Almost one-third of patients with primary or secondary syphilis who were untreated can develop the late manifestations such as cutaneous syphilis, neurosyphilis, or cardiovascular syphilis.

According to history a 48-year-old woman presented with a painless ulcerated plaque on her face for 2 months. At another hospital, she had been treated with antibiotics and antiviral therapies with repetitive dressings, which was not successful. She was previously healthy and denied trauma and skin cancer history.

A nontender dusky-red to brown plaque with deep, centrally punched-out ulcers covered with some crusts and necrotic debris. (B) A significant improvement shown after three intramuscular injections of penicillin G.

Courtesy Ann Dermatol. 2018 Dec;30(6):749-751. The Korean Dermatological Association and The Korean Society for Investigative Dermatology

Fig. 1. (A) A non-tender dusky-red to the brown plaque with deep, centrally punched-out ulcers covered with some crusts and necrotic debris. (B) A significant improvement is shown after three intramuscular injections of penicillin G.

Her physical examination showed a 4×4 cm crater-shaped plaque with crusts and oozing. Provisional diagnosis included pyoderma gangrenosum and squamous cell carcinoma. Skin biopsy demonstrated extensive necrosis and large areas of granulomatous inflammation within the dermis, including numerous multinucleated giant cells and marked lymphoplasmacytic infiltrates.

A rapid plasma reagin test was reactive (1:16), and fluorescent treponemal antibody-absorption (FTA-ABS) tests for immunoglobulin M (IgM) and immunoglobulin G were both positive. A human immunodeficiency virus (HIV) test was negative. Only then did the patient mention that she was inadequately treated for syphilis 20 years ago. 

Taken together, she was finally diagnosed with a syphilitic gumma. Further workup including cerebrospinal fluid analysis did not reveal any evidence of internal organ involvement. The lesion was significantly improved after three intramuscular injections of 2.4 million units of penicillin G.

Carry Home Points:-

  • Cutaneous tertiary syphilis accounts for about 16% of them. The time to progress to tertiary syphilis varies from several months to 35 years after infection.
  • As cutaneous tertiary syphilis clinically simulates many other skin diseases, its diagnosis should depend on a comprehensive interpretation of the patient’s medical history, pathologic findings, and serology results.

For more details click on the link: https://doi.org/10.5021/ad.2018.30.6.749

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Source: With inputs from Annals of Dermatology

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