Sífilis secundaria en vulva: una presentación inusual
Syphilis is an infection caused by the bacterium Treponema pallidum, transmitted through sexual contact, congenital transmission, and perinatal transmission. It affects people between 15 and 49 years of age and is curable. Known as the " the great simulator” due to the diversity of clinical pre...
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| Autores principales: | , , , , , , , |
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| Formato: | Artículo revista |
| Lenguaje: | Español |
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2025
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| Materias: | |
| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/50388 |
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| Sumario: | Syphilis is an infection caused by the bacterium Treponema pallidum, transmitted through sexual contact, congenital transmission, and perinatal transmission. It affects people between 15 and 49 years of age and is curable. Known as the " the great simulator” due to the diversity of clinical presentations, the recent increase in cases, and the lack of timely diagnosis and treatment, it alerts us to rare manifestations, such as secondary syphilis (SS). This entity presents: a maculopapular skin rash primarily on the trunk (roseola) and/or the palms and soles, pinkish; flat condylomas in the anogenital area or medial thighs; and mucous plaques on the tongue, lips, and mouth. Differential diagnoses include condylomata acuminata (CA), fibroepithelial polyps (FP), squamous cell cancer, among others. Histopathologically, they present a lymphoplasmacytic infiltrate with or without obliterative endarteritis. The combination of psoriasiform, lichenoid, and spongiotic patterns and the presence of numerous plasma cells is indicative of SS. This case report is notable for the unusual clinical manifestation of SS on the vulva, with no other mucocutaneous involvement.
CASE PRESENTATION: A 50-year-old female patient presented with multiple condylomatous lesions on the vulva and anus, with a 4-month of evolution and no other condition. Based on the suspected diagnosis of CA, the Gynecology and Dermatology Department decided to carry out a biopsy. Macroscopically, an elevated, light-brown lesion measuring 0.8 x 0.6 cm was observed. Microscopically, the epidermis showed hyperkeratosis and accumulations of polymorphonuclear neutrophils on the surface, and pseudoepitheliomatous hyperplasia with moderate spongiosis. The dermis revealed a moderate to intense lymphoplasmacytic inflammatory infiltrate with polymorphonuclear neutrophils and marked transepithelial migration. A diagnosis of a vulvar lesion with a neutrophilic spongiotic pattern and predominantly plasmacytic inflammation was reached. Based on the morphological characteristics, the lesion likely suggested SS, but AC was ruled out. A VDRL was performed, confirming the diagnosis of SS. Treatment with intramuscular penicillin was indicated, and the lesion resolved completely.
We describe an unusual clinical manifestation of SS in the vulva, which is clinically relevant to considering differential diagnoses such as AC and PF. We emphasize the value of the biopsy, which guided the diagnosis, and later confirmed by serology, ruling out other pathologies, allowing for early diagnosis, timely treatment, and resolution, highlighting the multidisciplinary approach. |
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