SHM Converge Scientific Abstract ePoster Gallery-When Syphilis Turns Malignant

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This case report describes malignant syphilis, a rare and severe form of secondary syphilis that usually affects immunocompromised patients, especially those with HIV. Despite the name, it is not cancer; it refers to the aggressive skin and systemic manifestations. The report also notes that syphilis rates remain high in the U.S., California, and San Diego, making awareness and early diagnosis important.<br /><br />A 66-year-old unhoused man with substance use disorder presented with fatigue, malaise, generalized pain, and several weeks of diffuse, painful, crusted skin lesions, especially on the face and scalp. He reported a recent sexual encounter after years of inactivity. Workup showed a positive syphilis screen with an RPR titer of 1:128, negative HIV testing, reactive hepatitis C antibodies with negative RNA, and evidence of prior hepatitis B exposure. A wound culture grew MSSA. Skin biopsy showed ulcerated granulomatous inflammation with abundant plasma cells, consistent with syphilis, although immunohistochemistry for T. pallidum was negative.<br /><br />The patient was treated with a single intramuscular dose of benzathine penicillin G, five days of IV cefepime for the superimposed MSSA infection, and surgical debridement of extensive lesions. He required burn-unit wound care afterward, and his lesions improved rapidly.<br /><br />The report emphasizes that malignant syphilis can occur even in immunocompetent patients, particularly in those with chronic illness, poor nutrition, substance use, or socioeconomic vulnerability. Diagnosis may be difficult because T. pallidum staining can be negative in later disease. Clinicians should maintain a high suspicion for syphilis in patients with diffuse ulcerative or crusted lesions so treatment can begin promptly.

Asset Subtitle

Kristina Djekic

Meta Tag

Author List Isabel Philip, Kristina Djekic

Category Clinical Vignettes

Concept Syphilis

Concept Malignant Syphilis

Concept Penicillin

Concept Primary Syphilis

Concept Secondary Syphilis

Distinguished Non-Finalist

Presenter Organization UC San Diego Health

Presenting Author Kristina Djekic

Track Adult

Keywords

malignant syphilis

secondary syphilis

diffuse skin lesions

benzathine penicillin G

RPR titer

HIV negative

plasma cell infiltrate

T. pallidum

MSSA infection

burn-unit wound care

Syphilis

Malignant Syphilis

Penicillin

Primary Syphilis

Secondary Syphilis