{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T20:14:19Z","timestamp":1770754459952,"version":"3.50.0"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,6,2]],"date-time":"2021-06-02T00:00:00Z","timestamp":1622592000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,6,2]],"date-time":"2021-06-02T00:00:00Z","timestamp":1622592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The clinical manifestations of recent syphilis can be variable, with typical and atypical patterns. Several conditions may cause atypical clinical aspects, including human immunodeficiency virus (HIV) co-infection. Besides the clinical features, co-infections may completely alter syphilis serological tests, causing interpretative difficulties and diagnostic delays. Aim of the work is to describe the difficulties encountered during the diagnostic evaluation of atypical skin manifestations and of the serology for syphilis of an HIV-infected patient who had contracted it several times.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>In 2020,\u00a0a 52-year old HIV-positive bisexual male patient was admitted to our department with a 4-month history of moderately itchy cutaneous lesions localized at his neck, trunk and arms. In 2013, the patient presented with a classic syphilitic roseola of the trunk and a secondary syphilis was diagnosed, with increased levels of rapid plasma reagin (RPR), Treponema pallidum hemagglutination assay (TPHA), anti-Treponema pallidum IgM and IgG Index. A second episode occurred in 2018, as a primary syphilis with multiple ulcerative lesions of the penis, and increased levels of RPR, IgG and IgM. In 2019, a further episode of secondary syphilis was treated with Doxycycline. In 2020, erythematous and papular lesions with vesicular components and urticarial erythema multiforme (EM)-like lesions were present at the neck, trunk and arms. Serological tests and Nucleic Acid Amplification Test (NAAT) for Treponema Pallidum were performed, as well as a cutaneous biopsy with histological and immunohistochemical evaluation of one lesion. NAAT was negative for <jats:italic>T. pallidum<\/jats:italic>. Serological test results were discordant with a new syphilis infection, showing only increased levels of RPR and anti-Treponema IgG. The cutaneous biopsy revealed a non specific histological pattern, while the immunohistochemical evaluation with anti-spirochetal antibodies was mandatory for the diagnosis of recent syphilis, showing clusters of rod-shaped elements, some of which with spiral form, focally present at the epidermis and adnexal structures.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Nowadays, syphilis may present with atypical clinical and serological features. Physicians should be aware of these possible alterations and consider syphilis even in case of uncommon clinical aspect and unclear serological tests. Cutaneous biopsy and immunohistochemical exam may be mandatory for the diagnosis.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-021-06199-0","type":"journal-article","created":{"date-parts":[[2021,6,2]],"date-time":"2021-06-02T20:04:38Z","timestamp":1622664278000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Unusual clinical manifestation and challenging serological interpretation of syphilis: insights from a case report"],"prefix":"10.1186","volume":"21","author":[{"given":"F.","family":"Magri","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. G.","family":"Don\u00e0","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Panetta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Pontone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Pimpinelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N.","family":"Cameli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Cristaudo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5763-0650","authenticated-orcid":false,"given":"M.","family":"Zaccarelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Latini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,6,2]]},"reference":[{"issue":"9","key":"6199_CR1","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1056\/NEJMra1901593","volume":"382","author":"KG Ghanem","year":"2020","unstructured":"Ghanem KG, Ram S, Rice PA. The modern epidemic of syphilis. N Engl J Med. 2020;382(9):845\u201354. https:\/\/doi.org\/10.1056\/NEJMra1901593.","journal-title":"N Engl J Med"},{"issue":"4","key":"6199_CR2","first-page":"266","volume":"52","author":"MO K\u00f6ksal","year":"2020","unstructured":"K\u00f6ksal MO, Beka H, Evlice O, et al. Syphilis seroprevalence among HIV-infected males in Istanbul, Turkey. Rev Argent Microbiol. 2020;52(4):266.","journal-title":"Rev Argent Microbiol"},{"issue":"3","key":"6199_CR3","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1136\/sti.2010.047514","volume":"87","author":"SC Kalichman","year":"2011","unstructured":"Kalichman SC, Pellowski J, Turner C. Prevalence of sexually transmitted co-infections in people living with HIV\/AIDS: systematic review with implications for using HIV treatments for prevention. 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Eur J Int Med. 2009;20(1):9\u201313. https:\/\/doi.org\/10.1016\/j.ejim.2008.04.002.","journal-title":"Eur J Int Med"},{"issue":"3","key":"6199_CR6","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1177\/0956462418805197","volume":"30","author":"H Liu","year":"2019","unstructured":"Liu H, Goh BT, Huang T, Liu Y, Xue R, Ke W, et al. Secondary syphilis presenting as erythema multiforme in a HIV-positive homosexual man: a case report and literature review. Int J STD AIDS. 2019;30(3):304\u20139. https:\/\/doi.org\/10.1177\/0956462418805197.","journal-title":"Int J STD AIDS"},{"issue":"RR-03","key":"6199_CR7","first-page":"1","volume":"64","author":"Centers for Disease Control and Prevention","year":"2015","unstructured":"Centers for Disease Control and Prevention. Sexually Transmitted Diseases Guidelines. MMWR Recomm Rep. 2015;64(RR-03):1\u2013137.","journal-title":"MMWR Recomm Rep"},{"issue":"4","key":"6199_CR8","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1001\/archderm.141.4.431","volume":"141","author":"AA Kingston","year":"2005","unstructured":"Kingston AA, Vujevich J, Shapiro M, Hivnor CM, Jukic DM, Junkins-Hopkins JM, et al. Seronegative secondary syphilis in 2 patients coinfected with human immunodeficiency virus. Arch Dermatol. 2005;141(4):431\u20133. https:\/\/doi.org\/10.1001\/archderm.141.4.431.","journal-title":"Arch Dermatol"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-021-06199-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-021-06199-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-021-06199-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,2]],"date-time":"2021-06-02T20:04:42Z","timestamp":1622664282000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-021-06199-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,2]]},"references-count":8,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["6199"],"URL":"https:\/\/doi.org\/10.1186\/s12879-021-06199-0","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,2]]},"assertion":[{"value":"17 June 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 May 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 June 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The patient gave written informed consent for his personal and clinical details along with medical images to be published in this study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"None to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"521"}}