Challenges in Treating Secondary Syphilis Osteitis in an Immunocompromised Patient with a Penicillin Allergy: Case Report and Review of the Literature.
Robert AliJulio C Perez-DownesFiras BaidounBashar Al TurkCarmen IsacheGirish MohanCharles PerniciaroPublished in: Case reports in infectious diseases (2016)
Syphilis is a sexually transmitted infection that remains fairly commonplace. The introduction of penicillin aided in curbing the incidence of disease; however, with the advent of the human immunodeficiency virus (HIV), syphilis is now on a resurgence with sometimes curious presentations. We present a case of a 36-year-old Caucasian gentleman with untreated HIV who complained of a skin eruption and joint pains for 6 weeks, prompting the diagnosis of secondary syphilis osteitis. Skin lesions were reminiscent of "malignant" syphilis. CD4 count was 57 cells/μL. RPR was elevated with 1 : 64 titer and positive confirmatory TP-PA. Radiography of the limbs revealed polyostotic cortical irregularities corroborated on bone scintigraphy. The patient had an unknown penicillin allergy and was unwilling to conduct a trial of penicillin-based therapy. He was subsequently treated with doxycycline 100 mg twice daily for 6 weeks and commenced antiretroviral therapy, noting dramatic improvement in both the skin lesions and joint pains. Unfortunately, he defaulted on follow-up, precluding serial RPR and bone imaging. Penicillin allergies have proven to be quite a conundrum in such patients, without much recourse for alternative therapy. Doxycycline with/without azithromycin is other options worth considering.
Keyphrases
- human immunodeficiency virus
- antiretroviral therapy
- hiv infected
- soft tissue
- hiv positive
- hepatitis c virus
- hiv aids
- hiv infected patients
- end stage renal disease
- bone mineral density
- wound healing
- induced apoptosis
- ejection fraction
- case report
- prognostic factors
- clinical trial
- high resolution
- hiv testing
- chronic kidney disease
- physical activity
- stem cells
- randomized controlled trial
- peritoneal dialysis
- computed tomography
- peripheral blood
- mass spectrometry
- study protocol
- bone marrow
- single cell
- photodynamic therapy
- gestational age
- oxidative stress
- south africa
- magnetic resonance
- pet ct
- phase ii
- phase iii
- atopic dermatitis
- endoplasmic reticulum stress
- bone regeneration
- patient reported