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A skin rash with multiple pulmonary nodules

Arthur Soares Souza Jr, Antonio Soares Souza, Gláucia Zanetti, Edson Marchiori
European Respiratory Review 2015 24: 682-683; DOI: 10.1183/16000617.00001815
Arthur Soares Souza Jr
1Dept of Radiology, Medical School of Rio Preto and Ultra X, São José do Rio Preto, Brazil
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Antonio Soares Souza
1Dept of Radiology, Medical School of Rio Preto and Ultra X, São José do Rio Preto, Brazil
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Gláucia Zanetti
2Dept of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Edson Marchiori
2Dept of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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  • For correspondence: edmarchiori@gmail.com
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Abstract

A case of pulmonary involvement in secondary syphilis http://ow.ly/TokOQ

A 37-year-old man presented with a 2-week history of fever and thoracic pain. On physical examination, he presented a nonpruritic skin rash (0.2–1-cm nontender pink papules) on the trunk (figure 1a), upper extremities, face and soles of the feet, which had developed about 2 months previously. He also had multiple palpable and painful lymph nodes. Additional history revealed that the patient had homosexual contact 3 months before the skin rash developed; a painless genital ulcer developed and then disappeared spontaneously.

FIGURE 1
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FIGURE 1

a) Photography showing skin rash on the trunk. b and c) Chest computed tomography images obtained at the level of the lower lobes showing multiple small, ill-defined nodules (arrows).

Routine blood test results were normal. Rapid plasma reagin and Venereal Disease Research Laboratory test results were positive. Computed tomography (CT) revealed multiple ill-defined pulmonary nodules, mostly in the lower lobes of the lungs (figure 1b and c). An open lung biopsy demonstrated a peribronchovascular infiltrate and alveolar spaces filled by plasmocytes and histiocytes, without necrosis. Biopsy of a skin lesion showed the same pattern. The patient's history and clinical, laboratory and histopathological findings were compatible with secondary syphilis. The patient was treated with penicillin. 8 weeks after treatment, complete regression of the skin lesions was observed and CT findings were normal.

The prevalence of syphilis has recently increased worldwide [1]. However, pulmonary involvement in secondary syphilis is extremely rare [2, 3]. To our knowledge, only seven cases of secondary syphilis with pulmonary involvement including CT findings have been published in the English-language literature. All of these cases presented with multiple pulmonary nodules. The association of pulmonary nodules with the characteristic skin lesions may aid diagnosis and the early institution of treatment.

Footnotes

  • Conflict of interest: None declared.

  • Provenance: Submitted article, peer reviewed.

  • Received February 18, 2015.
  • Accepted March 11, 2015.
  • Copyright ©ERS 2015.

ERR articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

References

  1. ↵
    1. Cohen SE,
    2. Klausner JD,
    3. Engelman J, et al.
    Syphilis in the modern era: an update for physicians. Infect Dis Clin North Am 2013; 27: 705–722.
    OpenUrlCrossRefPubMed
  2. ↵
    1. Kim SJ,
    2. Lee JH,
    3. Lee ES, et al.
    A case of secondary syphilis presenting as multiple pulmonary nodules. Korean J Intern Med 2013; 28: 231–235.
    OpenUrlCrossRefPubMed
    1. Alrajab S,
    2. Payne K,
    3. Areno J, et al.
    A 40-year-old man with a nodular lung disease and skin rash. Chest 2012; 141: 1611–1617.
    OpenUrlCrossRefPubMed
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A skin rash with multiple pulmonary nodules
Arthur Soares Souza Jr, Antonio Soares Souza, Gláucia Zanetti, Edson Marchiori
European Respiratory Review Dec 2015, 24 (138) 682-683; DOI: 10.1183/16000617.00001815

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A skin rash with multiple pulmonary nodules
Arthur Soares Souza Jr, Antonio Soares Souza, Gláucia Zanetti, Edson Marchiori
European Respiratory Review Dec 2015, 24 (138) 682-683; DOI: 10.1183/16000617.00001815
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