When Psoriasis Isn’t Psoriasis: Psoriasiform Syphilis and the Hidden Prozone Phenomenon
DOI:
https://doi.org/10.66344/jpad.v36i2.3301Keywords:
Syphilis, secondary syphilis, psoriasiform syphilis, prozone phenomenonAbstract
Treponema pallidum is the causative agent of syphilis, a systemic infection transmitted sexually or congenitally. Syphilis may present atypically in patients with HIV. A 25-year-old homosexual man with a 3-month history of weight loss and a 3-week history of generalized erythematous, scaly, psoriasiform lesions involving the face, scalp, trunk, extremities, palms, soles, and penis, accompanied by painless penile ulcers and intermittent pruritus. Laboratory evaluation revealed HIV infection with severe immunosuppression (CD4 189/µL), a nonreactive RPR, and a highly reactive TPHA (1:2560). Skin biopsy demonstrated psoriasiform with plasma cell infiltration, supporting the diagnosis of psoriasiform secondary syphilis in an HIV-infected patient. Treatment with antiretroviral therapy, cotrimoxazole, and weekly benzathine penicillin G for three weeks resulted in marked clinical improvement and a significant decline in RPR titers. This case highlights the need for clinical awareness of psoriasiform syphilis, careful interpretation of serologic tests in HIV patients.
Keywords: Syphilis, secondary syphilis, psoriasiform syphilis, prozone phenomenon
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