SHM Converge Scientific Abstract ePoster Gallery-The Great Imitator: A Rare Case of Lues Maligna in an Hiv-Positive Patient.

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This poster describes a rare case of <strong>lues maligna</strong>, an unusual and severe form of <strong>secondary syphilis</strong>, in a <strong>54-year-old HIV-positive man</strong> with a history of prior syphilis, inflammatory bowel disease, and hypertension. He presented with a <strong>non-pruritic rash</strong> that began as circular macules on the <strong>face</strong> and spread to the <strong>trunk and extremities</strong>, sparing the palms and soles initially. The lesions became <strong>nodular, ulcerated, crusted, painful, and foul-smelling</strong>, and his dog had been licking them. He was also febrile and fatigued, and he had been <strong>noncompliant with antiretroviral therapy</strong>.

Because the skin findings were atypical, the differential diagnosis included <strong>fungal infection, mycobacterial infection, pyoderma gangrenosum</strong> related to IBD, and <strong>herpetic infection</strong>. He was started empirically on broad-spectrum antibiotics. Cultures from the lesions grew <strong>methicillin-sensitive Staphylococcus aureus</strong>, so treatment was narrowed to doxycycline, and the lesions improved. However, the key diagnostic clues were <strong>elevated RPR titers (1:32)</strong> and <strong>skin biopsy findings</strong> showing mixed inflammatory infiltrates consistent with secondary syphilis, confirming <strong>lues maligna</strong>.

He was treated with <strong>intramuscular benzathine penicillin G, 2.4 million units</strong>, for secondary syphilis. The poster emphasizes that syphilis can mimic many conditions, making diagnosis challenging, especially in <strong>HIV-infected patients</strong>. It highlights the importance of maintaining a <strong>high index of suspicion</strong> and using both <strong>serologic and histopathologic testing</strong> to establish the diagnosis.

Asset Subtitle

Fadi Samaan

Meta Tag

Author List Fadi Samaan

Category Clinical Vignettes

Concept Malignant Syphilis

Concept Secondary Syphilis

Concept Penicillin G

Concept HIV

Concept Skin Lesion

Distinguished Non-Finalist

Presenter Organization Lifespan

Presenting Author Fadi Samaan

Track Adult

Keywords

lues maligna

secondary syphilis

HIV-positive

non-pruritic rash

skin biopsy

RPR titer

benzathine penicillin G

Staphylococcus aureus

pyoderma gangrenosum

serologic testing

Malignant Syphilis

Secondary Syphilis

Penicillin G

HIV

Skin Lesion