Robyn M. Atkinson
A 43-year-old male presented to the infectious disease clinic with a 2-month history of worsening skin rash and lesions. The lesions were not painful and were predominantly on his face and forearms, but also covered the palms of his hands and soles of his feet. He was treated one month prior to this presentation with azithromycin, and the rash had improved slightly. In addition to the worsening rash and skin lesions, he noted the development of painless lesions on his penis that were resolving at the time of presentation. He also reported a history of night sweats, which coincided with the appearance of the rash, a sore throat, mild weight loss, headaches without visual alterations, and mild neck stiffness. The day prior to presentation he noted a single episode of anal discharge that was yellow and nonbloody. He had no history of fever, chills, nausea, vomiting, diarrhea, or penile discharge.
His past medical history is significant for HIV, which was diagnosed 24 years earlier, idiopathic thrombocytopenic purpura resulting in a splenectomy 16 years earlier, and bipolar disorder diagnosed 18 years earlier with a suicide attempt 5 years ago. He has been on intermittent HAART therapy and his infectious disease history is positive for hepatitis B, gonorrhea, HPV (human papilloma virus) with anal warts, and herpes simplex virus 1 and 2. His most recent PPD skin test (purified protein derivative) for tuberculosis was negative.
On physical examination, he was well-appearing and pleasant. His neurological exam was normal; his neck was supple, yet there was decreased range of motion with nontender bilateral submandibular lymphadenopathy. No mucosal lesions were noted; penile lesions were erythematous, approximately 0.5 cm in diameter, and slightly raised. The lesions on the face and forearms were up to 0.7 cm in diameter and appeared excoriated with an eschar. There were two nonerythematous nontender raised ulcerated lesions on his palms and three such lesions on the bottoms of his feet. The clinic was suspicious for secondary syphilis and ordered a serum RPR (rapid plasma reagin), which was positive at 1: 256. A follow-up FTA-ABS (fluorescent treponemal antibody absorbed test) was also reactive. At this time, the patient reported having sexual contact with a partner about a year ago who initially reported a history of syphilis and then later denied that information.
Given his HIV status and secondary syphilis diagnosis, he was admitted for a lumbar puncture to rule out neurosyphilis. His CSF revealed a total of 93 cells, with two nucleated cells. Glucose was normal at 59 mg/dL, and protein was slightly elevated at 62 mg/dL.
A CSF VDRL (Venereal Disease Research Laboratory test) was reactive at a dilution of 1: 16. He was diagnosed with secondary syphilis with concurrent neurosyphilis and was treated with intravenous penicillin G for 14 days.
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Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.