{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T03:25:26Z","timestamp":1784690726624,"version":"3.55.0"},"reference-count":83,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,6,6]],"date-time":"2024-06-06T00:00:00Z","timestamp":1717632000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infectious Disease Reports"],"abstract":"<jats:p>We report the case of a 28-year-old male with uncontrolled human immunodeficiency virus (HIV) infection who presented with extensive ulcerated lesions with dark lamellated crusting on his face, torso, and limbs. The patient had a rapid plasma reagin (RPR) titer of 1:512, indicative of syphilis. A skin biopsy revealed granulomata surrounded by lymphocytes, histiocytes, and plasma cells, with spirochetes visible on immunohistochemical staining. The patient\u2019s rash resolved with hyperpigmented scarring after penicillin and doxycycline treatment. This severe form of secondary syphilis has been termed malignant syphilis, lues maligna, ulceronodular syphilis, or rupioid syphilis. We propose a single descriptive name for this entity, ulceronodular-rupioid syphilis. In 1969, Fisher proposed criteria for malignant syphilis based on lesion appearance, histopathologic findings, high RPR values, and rapid response to treatment. We found that the Fisher criteria were imprecise with respect to specific histopathologic findings, the quantitation of RPR values, and what constitutes rapid response to treatment. Thus, we examined an additional 74 cases from the literature and propose new diagnostic criteria based on rash appearance, histopathologic characteristics, non-treponemal and treponemal test positivity, and response to therapy. We also found that uncontrolled viremia, and not a low CD4 count, is a major risk factor for ulceronodular-rupioid syphilis in HIV patients.<\/jats:p>","DOI":"10.3390\/idr16030038","type":"journal-article","created":{"date-parts":[[2024,6,6]],"date-time":"2024-06-06T12:04:28Z","timestamp":1717675468000},"page":"499-518","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["An Exuberant Case of Ulceronodular-Rupioid (Malignant) Syphilis in an HIV Patient: A Proposal for New Diagnostic Criteria"],"prefix":"10.3390","volume":"16","author":[{"given":"Dennys","family":"Jimenez","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian Santillan","family":"Rabe","sequence":"additional","affiliation":[{"name":"Family-Focused AIDS Clinical Treatment Services Clinic, University Health System, 903 W. Martin St., San Antonio, TX 78207, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6075-8137","authenticated-orcid":false,"given":"Apeksha N.","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott R.","family":"Dalton","sequence":"additional","affiliation":[{"name":"Sagis Diagnostics, PLLC, 4131 Directors Row, Houston, TX 77092, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5473-9375","authenticated-orcid":false,"given":"Gregory M.","family":"Anstead","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA"},{"name":"Family-Focused AIDS Clinical Treatment Services Clinic, University Health System, 903 W. Martin St., San Antonio, TX 78207, USA"},{"name":"Medical Service, Division of Infectious Diseases, South Texas Veterans Healthcare System, 7400 Merton Minter Blvd., San Antonio, TX 78229, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1016\/S0140-6736(16)32411-4","article-title":"3rd. Syphilis","volume":"389","author":"Hook","year":"2017","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1086\/594127","article-title":"Malignant syphilis with ocular involvement and organism-depleted lesions","volume":"48","author":"Pleimes","year":"2009","journal-title":"Clin. Infect. 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