Abstract：
Malignant syphilis (MS) is a rare form of secondary syphilis with grotesque skin lesions, systemic manifestation and life-threatening complications. This article presents a case of MS in an immunocompetent 41-year-old female, who initially manifested with a generalized nonpruritic erythematous rash and systemic symptoms. She was mistreated for generalized impetigo and hepatitis attributed to chronic alcoholism. After partial recovery and a 3-month latent period, she developed infiltrated plaques with crusts on the trunk, head and neck; pharyngitis and laryngeal lesions; generalized lymphadenopathy and nonspecific systemic symptoms. Serologic tests confirmed syphilis, and cerebrospinal fluid analyses indicated the presence of anti-treponemal antibodies. Urine drug screening was positive for cannabinoids. The polymerase chain reaction from skin biopsy samples identified T. pallidum, confirmed with Warthin-Starry staining. Immunohistochemical analysis was uncharacteristic. Tertiary syphilis, neurosyphilis, ocular syphilis and otosyphilis were excluded. However, the patient was treated for neurosyphilis with benzylpenicillin (18 million IU intravenously daily, 14 days) and corticosteroids. No Jarisch-Herxheimer reaction occurred. Ten months after treatment, residual scars were visible, and 1 year later, she attempted suicide. Since MS can resemble other diseases, it should be suspected in a mentally ill patient with chronic drug abuse, systemic nonspecific manifestations and dermatological abnormalities, including the head and neck region.
摘要：
恶性梅毒（MS）是一种罕见的继发性梅毒，具有怪诞的皮肤病变，全身表现和危及生命的并发症。本文介绍了一例41岁免疫功能正常的女性MS，最初表现为全身性非瘙痒性红斑皮疹和全身症状。她因慢性酒精中毒引起的全身性脓疱病和肝炎而受到虐待。经过部分恢复和3个月的潜伏期，她在树干上形成了浸润的斑块，结皮，头颈部；咽炎和喉部病变；全身淋巴结肿大和非特异性全身症状。血清学检查证实梅毒，和脑脊液分析表明存在抗螺旋体抗体。尿液药物筛查大麻素阳性。来自皮肤活检样本的聚合酶链反应鉴定出梅毒螺旋体，用Warthin-Starry染色证实。免疫组织化学分析没有特征性。三级梅毒,神经梅毒,眼梅毒和耳梅毒被排除。然而,患者接受了神经梅毒用青霉素治疗（每天静脉注射1800万IU，14天）和皮质类固醇。没有发生Jarisch-Herxheimer反应。治疗后10个月,残留的疤痕是可见的，一年后，她企图自杀.由于MS可以类似于其他疾病，在患有慢性药物滥用的精神病患者中应该怀疑它，全身非特异性表现和皮肤病学异常，包括头部和颈部。
