15 / 90
S
econdary
syphilis
: T
he
great
imitator
can
’
t
be
forgotten
R
ev
A
ssoc
M
ed
B
ras
2017; 63(6):481-483
483
main difference between these two diseases is that syph-
ilitic lesions are usually nonpruritic and they tend to affect
palms and soles.
5
Our patient also had annular lesions with well-defined
scaly borders on the palms and soles, a well-described
feature of secondary syphilis;
6
some of these lesions were
thicker than others and also displayed a violaceous hue.
This finding should remind dermatologists of a variety
of conditions in the differential diagnosis, including lichen
planus, subacute lupus erythematosus, sarcoidosis, my-
cobacterial infection, granuloma annulare, erythema
annulare centrifugum and dermatophytosis.
6
Mucous plaques and split papules at the angle of the
lips are other findings of secondary syphilis; the latter was
observed in our patient.
1
Secondary syphilis diagnosis in daily practice includes
clinical suspicion due to the presence of characteristic skin
and mucous lesions and confirmation by serologic tests
that measure nontreponemal and treponemal antigens.
8
Treatment of choice remains benzathine penicillin G, and
quantitative titers of VDRL are used to verify treatment
success together with the clearance of lesions.
9
In addition,
sexual partners must be examined and tested for syphilis.
3
To conclude, physicians must be aware of syphilis:
the spectrum of cutaneous manifestations is vast and
rates of this infection keep rising worldwide.
C
onflict
of
interest
The authors declare no conflict of interest.
R
esumo
Sífilis secundária: a grande imitadora não pode ser esquecida
A sífilis é uma infecção causada pela espiroqueta
Trepone-
ma pallidum
, transmitida principalmente por contato
sexual. Desde 2001, houve o ressurgimento dessa epidemia,
com aumento das taxas de sífilis primária e secundária.
Os autores descrevem um caso exuberante de sífilis se-
cundária apresentando lesões cutâneas anulares e lesões
que lembram líquen plano, além de uma lesão mucocu-
tânea. Médicos de todas as especialidades devem estar
cientes das diversas apresentações de sífilis: o vasto espec-
tro de manifestações cutâneas da sífilis secundária e as
crescentes taxas dessa patologia representam um desafio.
Palavras-chave:
sífilis cutânea, doenças sexualmente
transmissíveis, penicilina G benzatina,
Treponema pallidum
.
R
eferences
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