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Diffuse Hair Loss in Secondary Syphilis in HIV Positive Man: Case Report
Milan Bjeki?
Acta Facultatis Medicae Naissensis , 2012,
Abstract: Hair loss is not a common feature of secondary syphilis. There are two types of syphilitic alopecia: “symptomatic” type where hair loss is associated with other symptoms of secondary syphilis, and “essential” alopecia that is either patchy (“moth-eaten” type), diffuse pattern with a generalized thinning of the scalp hair, or a combination of both without any other mucocutaneous signs of syphilis. This article presents a case of syphilitic alopecia in a 30-year-old homosexual man. The patient had diffuse non-scarring alopecia of his scalp and loss of eyelashes and eyebrows. A macular rash with palmar-plantar involvement and oral lesions coexisted with the hair loss. Serological tests for syphilis were positive. The patient was treated with a single dose of benzathine penicillin G, 2.4 million units intramuscularly. Within three months there was dramatic hair regrowth, and all syphilitic lesions resolved. Patient was councelled and tested on HIV. The HIV seropositivity was confirmed by Western blot analysis. Syphilitic alopecia should not be overlooked in patients with non-scarring hair loss. Serologic testing for syphilis is recommended in patients with unexplained rapid hair loss. However, all patients presenting with syphilis should be offered HIV testing.
Prozone effect of serum IgE levels in a case of plasma cell leukemia
Giampaolo Talamo, William Castellani, Nathan G Dolloff
Journal of Hematology & Oncology , 2010, DOI: 10.1186/1756-8722-3-32
Abstract: IgE myeloma is a very rare subtype of MM, and it represents < 0.01% of all plasma cell dyscrasias [1]. Since the first case was described in 1967 [2], approximately 47 cases of IgE MM have been reported in the literature [3-6]. IgE antibodies are named from the ragweed E antigen, which was used for their isolation, and they are involved in allergic responses, atopic conditions, helminthic and respiratory infections, and chronic inflammatory diseases [7]. It is important to note that commonly available serum immunofixation (IFE) testing screens only for monoclonal IgG, IgM, and IgA chains. Therefore, IFE specific for IgD and IgE should be requested when these rare subtypes are suspected (e.g., when a monoclonal protein has been detected by SPEP, but routine IFE is negative). The clinical manifestations of IgE MM are similar to those seen in other MM subtypes, but some experts consider IgE MM an aggressive disease, associated with a significantly higher rate of plasma cell leukemia [8,9]. Other data do not support the aggressive nature of this subtype of MM. A review of the first 19 reported cases of IgE MM showed no difference in the incidence of extramedullary plasma cell infiltration compared with other subtypes of the disease [10].We describe a case of IgE-kappa MM and secondary PCL with falsely normal serum levels of IgE due to the prozone effect.A 53 year-old Caucasian man with unremarkable past medical history was diagnosed with MM in November of 2006. He presented with back pain, and MRI of the spine revealed multiple compression fractures. Skeletal survey was negative for lytic lesions. Bone marrow aspirate revealed 75% kappa-restricted atypical plasma cells, establishing the diagnosis of MM. Cytogenetic analysis was normal, and the translocation t(11;14) was the only abnormality detected by the MM FISH panel. IFE was positive for monoclonal IgE-kappa proteins, IgE level was 5,300,000 IU/mL, serum free kappa was normal, and Bence-Jones proteinuria was absent.
Assessment of the prozone effect in malaria rapid diagnostic tests  [cached]
Gillet Philippe,Mori Marcella,Van Esbroeck Marjan,Ende Jef
Malaria Journal , 2009,
Abstract: Background The prozone effect (or high doses-hook phenomenon) consists of false-negative or false-low results in immunological tests, due to an excess of either antigens or antibodies. Although frequently cited as a cause of false-negative results in malaria rapid diagnostic tests (RDTs), especially at high parasite densities of Plasmodium falciparum, it has been poorly documented. In this study, a panel of malaria RDTs was challenged with clinical samples with P. falciparum hyperparasitaemia (> 5% infected red blood cells). Methods Twenty-two RDT brands were tested with seven samples, both undiluted and upon 10 ×, 50 × and 100 × dilutions in NaCl 0.9%. The P. falciparum targets included histidine-rich protein-2 (HRP-2, n = 17) and P. falciparum-specific parasite lactate dehydrogenase (Pf-pLDH, n = 5). Test lines intensities were recorded in the following categories: negative, faint, weak, medium or strong. The prozone effect was defined as an increase in test line intensity of at least one category after dilution, if observed upon duplicate testing and by two readers. Results Sixteen of the 17 HRP-2 based RDTs were affected by prozone: the prozone effect was observed in at least one RDT sample/brand combination for 16/17 HRP-2 based RDTs in 6/7 samples, but not for any of the Pf-pLDH tests. The HRP-2 line intensities of the undiluted sample/brand combinations with prozone effect (n = 51) included a single negative (1.9%) and 29 faint and weak readings (56.9%). The other target lens (P. vivax-pLDH, pan-specific pLDH and aldolase) did not show a prozone effect. Conclusion This study confirms the prozone effect as a cause of false-negative HRP-2 RDTs in samples with hyperparasitaemia.
Assessment of the prozone effect in malaria rapid diagnostic tests
Philippe Gillet, Marcella Mori, Marjan Van Esbroeck, Jef Ende, Jan Jacobs
Malaria Journal , 2009, DOI: 10.1186/1475-2875-8-271
Abstract: Twenty-two RDT brands were tested with seven samples, both undiluted and upon 10 ×, 50 × and 100 × dilutions in NaCl 0.9%. The P. falciparum targets included histidine-rich protein-2 (HRP-2, n = 17) and P. falciparum-specific parasite lactate dehydrogenase (Pf-pLDH, n = 5). Test lines intensities were recorded in the following categories: negative, faint, weak, medium or strong. The prozone effect was defined as an increase in test line intensity of at least one category after dilution, if observed upon duplicate testing and by two readers.Sixteen of the 17 HRP-2 based RDTs were affected by prozone: the prozone effect was observed in at least one RDT sample/brand combination for 16/17 HRP-2 based RDTs in 6/7 samples, but not for any of the Pf-pLDH tests. The HRP-2 line intensities of the undiluted sample/brand combinations with prozone effect (n = 51) included a single negative (1.9%) and 29 faint and weak readings (56.9%). The other target lens (P. vivax-pLDH, pan-specific pLDH and aldolase) did not show a prozone effect.This study confirms the prozone effect as a cause of false-negative HRP-2 RDTs in samples with hyperparasitaemia.Malaria rapid diagnostic tests (RDTs) are lateral flow immunochromatographic tests that detect Plasmodium antigens by antibody-antigen interactions on a nitrocellulose test strip. Capillary or venous blood and a lysis buffer are added to the strip: if present in the sample, the Plasmodium antigen is bound to a detection antibody. This detection antibody is usually a monoclonal mouse-antibody conjugated to a signal, mostly colloidal gold. The antigen-detection antibody-conjugate complex diffuses further across the strip until it is bound to a second antibody: this so-called capture antibody reacts to another epitope of the target antigen. As the capture antibody is fixed on a narrow section of the strip, the conjugated signal is concentrated and becomes visible as a cherry-red or purple colored line. The excess of detection antibody-conju
Mucous patch on the tongue as isolated manifestation of the secondary stage of syphilis: Case report
Bjeki? Milan,?ipeti? Sandra
Stomatolo?ki Glasnik Srbije , 2012, DOI: 10.2298/sgs1203160b
Abstract: Introduction. Syphilis is sexually transmitted infection caused by the anaerobic spirochete Treponema pallidum. Oral lesions are present and described in all stages of the disease. These lesions as well as blood and saliva of infected persons are highly contagious in early syphilis. The aim of this case report was to point out to the possibility of the secondary syphilis in differential diagnosis of oral diseases. Case Report. A 38-year-old asymptomatic man showed up at the clinic with suspicious of syphilis infection. Clinical presentation of the disease was a mucous patch on the tongue, however no other mucous membrane or cutaneous lesions were detected. No lymph nodes were enlarged. The serologic tests on syphilis were positive. After conducting systemic antibiotic therapy with benzathine penicillin the tongue lesion disappeared. Conclusion. Depending on the clinical picture, the possibility of syphilis should not be overlooked in the differential diagnosis of oral lesions.
Secondary Syphilis with Pleural Effusion: Case Report and Literature Review  [PDF]
Abdel-Naser Elzouki,Mustafa Al-Kawaaz,Zaid Tafesh
Case Reports in Infectious Diseases , 2012, DOI: 10.1155/2012/409896
Abstract: Here we present a case of a 38-year-old Indian man with a history of extramarital relationships who presented with pleurisy, skin rash, and radiological findings of pleural effusion. After thorough investigation of the etiology of his acute illness, he was found to be positive for syphilis. Review of literature revealed a small number of case reports of pleural effusion as a manifestation of secondary syphilis. The review of criteria proposed in the literature was utilized to diagnose this patient as a case of pulmonary syphilis. 1. Introduction Syphilis is a sexually transmitted illness caused by the organism Treponema pallidum. The infection itself is acquired mainly via sexual contact with clinical manifestations such as a chancre or skin rash. However, although less common, the infection can also be contracted by nonsexual contact, organ transplantation, blood transfusion, or in utero infection [1]. With the introduction of penicillin therapy to counter syphilis infection, the number of cases in the developed countries such as United States has decreased by 95% since 1943 [1]. The natural course of syphilis begins with an inoculation period of 21 days on average, rarely exceeding 6 weeks. Syphilis can present itself in three different stages, specifically primary, secondary, and tertiary syphilis, with each stage characterized by unique clinical manifestations. Although uncommon, report of pulmonary illness in patients with proven syphilis exists in the literature. Only a handful of cases report such involvement, with variable presentations reported. Pulmonary syphilis occurred mainly in congenital and tertiary syphilis in the preantibiotic era, but, since 1967, it has been occurring mainly during secondary syphilis [2]. David and his coworkers [2] sited Coleman et al. [3] regarding the fact that lung involvement in patients with syphilis during the preantibiotic area ranged from 1% to 12.5%. Here we present a case of a patient with suspected pulmonary syphilis, with significant pleural effusion and clinical and diagnostic evidence of syphilis infection. Our case is consistent with the fact that most infections are now related to cases resembling secondary syphilis. We chose to incorporate the diagnostic criteria for pulmonary syphilis proposed by Coleman et al which was presented by David et al. [2]. 2. Case Report A 38 year-old Indian man presented with a past medical history significant for recurrent low-grade fevers and a new diagnosis of Diabetes Mellitus being treated with metformin. He complained of pain in the right chest and right upper
Perforation of the palate in secondary syphilis  [cached]
Pavithran K
Indian Journal of Dermatology, Venereology and Leprology , 1994,
Abstract: A middle aged woman with secondary syphilis-diagnosed clinically and serologically was prescribed oral tetracyline. She did not complete the course of treatment. Recurrent mucosal erosions in the mouth she developed subsequently as manifestation of relapsing secondary syphilis were wrongly diagnosed as ′aphthous stomatitis′ and were treated with betamethasone gargling. The erosions progressed to ulcerations and finally resulted in perforation of the soft palate.
Hypertrophic mucosal lesions in secondary syphilis
Sharma R,Goel V,Sharma N,Maheshwari P
Indian Journal of Dermatology, Venereology and Leprology , 1992,
Abstract: A young male patient suffering from secondary syphilis had hypertrophic mucous membrane lesions. VDRL test was positive and lesions disappeared after adequate penicillin therapy.
Secondary syphilis in HIV infection - a diagnostic dilemma  [cached]
Panvelker V,Chari KVR,Verma A,Batra R
Indian Journal of Dermatology, Venereology and Leprology , 1997,
Abstract: A case of secondary syphilis in HIV infection is being reported. The patient presented with skin rash only. VDRL was found to be negative and HIV testing was positive. He was treated for secondary syphilis with clinical response. Blood VDRL test was subsequently reported as reactive.
Facial Nerve Palsy In Secondary Syphilis  [cached]
Masuria B.L,Batra A,Kothiwala R.K,Khuller R
Indian Journal of Dermatology , 1999,
Abstract: A case of secondary syphilis with right facial nerve palsy is reported. A 28 year old unmarried male presented with diffuse maculopapular rash and facial nerve palsy. He had elevated while cells and protein in cerebrospinal fluid. Serum and cerebrospinal fluid were positive for VDRL and TPHA tests. Facial nerve palsy and maculopapular rash improved with penicillin therapy.
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