背景:梅毒是由细菌梅毒螺旋体引起的感染。它主要通过口头传播,阴道和肛交,在怀孕期间和通过输血。梅毒发展于原发性,次要,潜伏期和第三期,每个阶段都有不同的临床特征。感染的患者可以保持几年无症状,如果没有治疗,可以,在极端情况下,表现为几个器官和组织的损伤,包括大脑,神经组织,眼睛,耳朵和软组织。在人类免疫缺陷病毒(HIV)负担较高的国家,梅毒会增加感染艾滋病毒的风险。我们报告了一名年轻的HIV阳性黑人妇女的病例,该妇女以脱发和色素减退为继发性梅毒的特征。
方法:一名接受抗逆转录病毒治疗(ART)的29岁女性在病毒学上受到抑制,她有短暂的全身性脱发史,伴有非瘙痒斑丘疹和足部皮肤色素脱失。有限的实验室检测证实诊断为二期梅毒。她接受了苄星青霉素2.4MU治疗。在接受三剂推荐治疗后,显示功能已清除,病人完全康复了.
结论:该病例证明了在表现为不典型的二期梅毒临床特征的患者中,高临床怀疑和梅毒检测指标的重要性,如脱发和色素减退。它还强调了在资源有限的环境中诊断和临床管理梅毒的挑战。
Syphilis is an infection caused by the bacteria Treponema pallidum. It is mainly transmitted through oral, vaginal and anal sex, in pregnancy and through blood transfusion. Syphilis develops in primary, secondary, latent and tertiary stages and presents with different clinical features at each stage. Infected patients can remain asymptomatic for several years and, without treatment, can, in extreme cases, manifest as damage in several organs and tissues, including the brain, nervous tissue, eyes, ear and soft tissues. In countries with a high human immunodeficiency virus (HIV) burden, syphilis increases the risk of HIV infections. We report the case of a young HIV-positive black woman who presented with alopecia and hypopigmentation as features of secondary syphilis.
A virologically suppressed 29-year-old woman on Anti-retroviral Therapy (ART) presented with a short history of generalized hair loss associated with a non-itchy maculopapular rash and skin depigmentation on the feet. Limited laboratory testing confirmed a diagnosis of secondary syphilis. She was treated with Benzathine Penicillin 2.4MU. After receiving three doses of the recommended treatment, the presenting features cleared, and the patient recovered fully.
This case demonstrates the importance of a high index of clinical suspicion and testing for syphilis in patients presenting with atypical clinical features of secondary syphilis, such as hair loss and hypopigmentation. It also highlights the challenges in diagnosing and clinically managing syphilis in a resource-limited setting.