Erschienen in:
01.12.2015 | Images in Infection
Alopecia syphilitica diffusa
verfasst von:
Alexander Zink, Katharina Kaliebe, Christoph D. Spinner
Erschienen in:
Infection
|
Ausgabe 6/2015
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Excerpt
A 27-year-old HIV-positive man (CDC stadium A2) on stable antiretroviral therapy with tenofovir disoproxil fumarate/emtricitabine/rilpivirine (TDF/FTC/RPV) (CD4 cell count 960/µl, HIV RNA not detectable) presented with clinical findings of a progressive hair loss on his scalp within only a few weeks. On request, a painless ulceration on the palate 6 weeks prior to actual presentation after unprotected oral intercourse with another man has been reported. On physical examination, a 1 cm in diameter large ulceration was observed on the mucosa of the hard palatine, as well as cervical lymphadenopathy. Laboratory evaluation revealed a reactive
Treponema pallidum particle agglutination assay (TPPA) and a Venereal Disease Research Laboratory (VDRL) test of 1:256 with known negative TPPA testing 5 months prior to actual presentation. Diagnosis of secondary syphilis with alopecia syphilitica diffusa, lymphadenopathy and persisting hard chancre was made. A treatment with a single gluteal, intramuscular injection of benzylpenicillin 2.4 million units [
1] following 60 mg prednisolone per os as prophylaxis against Jarisch–Herxheimer reaction led to complete resolved symptoms. Alopecia syphilitica is a rare and rather uncommon manifestation of secondary syphilis occurring in only about 5 % of syphilis patients [
2]. It can be the only clinical symptom of syphilis infection and mimic alopecia areata in clinical course or on histopathological findings [
3]. Syphilitic hair loss, suggested to be caused by the direct infection of hair follicles by
Treponema pallidum [
4], is non-inflammatory and noncicatricial and typically presents in a diffuse or in a moth-eaten pattern with multiple patches of non-scarring alopecia, or in a combination of both [
5,
6].
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