Case report of early malignant syphilis with ulcerated acute lesions

(Poster reference number 5688)

Soraya de Souza Chantre Oliveira, Hospital Mario Kroeff - FTESM, Rio De Janeiro,
Brazil; Anna Maria Salles, FIOCRUZ, Rio de Janeiro, Brazil; Guilherme Penfold,
Hospital Mario Kroeff - FTESM, Rio De Janeiro, Brazil; Jose Augusto da Costa
Nery, Hospital Mario Kroeff - FTESM, Rio De Janeiro, Brazil; Juliany Estefan,
Hospital Mario Kroeff - FTESM, Rio De Janeiro, Brazil; Rebeca Maiolino Pedro,
Hospital Mario Kroeff - FTESM, Rio De Janeiro, Brazil; Roberta Peres Vieira de
Melo, Hospital Mario Kroeff - FTESM, Rio De Janeiro, Brazil
Objective: The early malignant syphilis despite of already being of knowledge of the
dermatologist can still be considered a marker of HIV-positive. It is a rare form of
secondary syphilis, characterized by the appearance of papular-pustules and
ulcerated lesions, covered with crusts, followed by severe constitutional symptoms.
Case report: RCO, male, 28 years, homosexual, natural Bonsucessso-RJ, searched
medical help in our service with an erythematous-papular lesion, some ulcerated,
sometimes with Biet collarette, disseminated, followed by fever, patchy alopecia,
jaundice and epigastric pain. VDRL was performed with reagent result of 1:64, HIV
serology is negative, concluding the case as early malignant syphilis and underwent
therapy with benzathine penicillin 2.4 million IU in two shots.
Discussion: Early malignant syphilis is a serious evolutionary form of syphilis
characterized by secondary lesions and ulcerations. The literature has reported
cases of HIV patients with more aggressive and abrupt events, however, the case in
question follows the severity and progression of the disease in HIV-negative patients
or in the immunological window and this will be reassessed in six months to repeat
the anti-HIV test.
Commercial support: None identified.

Colonizing features of Staphylococcus aureus in patients with nummular

eczema

(Poster reference number 4979)

Won-Jeong Kim, MD, Department of Dermatology, School of Medicine, Pusan

National University, Busan, South Korea; Birendra Tiwari, Department of
Microbiology, Kyungpook National University School of Medicine, Daegu,
South Korea; Byung-Soo Kim, MD, PhD, Department of Dermatology, School of
Medicine, Pusan National University, Busan, South Korea; Do Won Kim, MD,
PhD, Department of Dermatology, Kyungpook National University School of
Medicine, Daegu, South Korea; Hyun-Chang Ko, MD, Department of
Dermatology, School of Medicine, Pusan National University, Busan, South
Korea; Jung-Min Kim, PhD, Department of Microbiology, Kyungpook National
University School of Medicine, Daegu, South Korea; Moon-Bum Kim, MD, PhD,
Department of Dermatology, School of Medicine, Pusan National University,
Busan, Korea, South
Nummular eczema (NE) is a common eczematous disorder characterized by coinshaped exudative plaques and it may be complicated by secondary bacterial
infection. Staphylococcus aureus is the one of common resident flora on the skin
and the positive correlation between the positive culture rate of S aureus and atopic
dermatitis has already been reported. However, the relation between S aureus
colonization and NE remains unknown. This study aimed to determine the
colonizing features of S. aureus in patients with NE and to relate presence of
S aureus and toxin production to severity of NE. We also tried to identify the source
of skin colonizing S aureus in patients with NE. From January 2011 to May 2011,
total of thirty subjects with NE and their close contacts participated in the study. The
severity of NE was evaluated by using EASI score and swabs for S aureus were
performed from skin (lesional or nonlesional skin), anterior nares, and subunguium
of all subjects. Further, all S aureus isolates were examined for their superantigenic
exotoxins and genotypic composition by polymerase chain reaction assay and
pulsed-field gel electrophoresis.
Commercial support: None identified.

Chronic cutaneous leishmaniasis resistant to antimonials: About a case

(Poster reference number 4716)

Lidia Gomez, MD, Instituto de Biomedicina, Caracas, Venezuela; Maria Panniello,

MD, Instituto de Biomedicina, Caracas, Venezuela; Olga Zerpa, MD, Instituto de
Biomedicina, Caracas, Venezuela; Oscar Reyes, MD, Instituto de Biomedicina,
Caracas, Venezuela. Dermatology and Syphilography Postgraduate Course,
Instituto de Biomedicina, Universidad Central de Venezuela
Background: Chronic cutaneous leishmaniasis represents 0.4% of the cutaneous
forms of leishmaniasis. Its clinical characteristics vary between verrucous, sarcoidal,
and chromomycoid plaques, or even chronic ulcers with a verrucous bed, single or
multiple. Parasitologic diagnosis is difficult because of the scarcity of parasites. It is
produced by Leishmania belonging to the subgenus Viannia and Leishmania.
Immunologically is characterized by a strong cell-mediated response with
Leishmanin values over 20 mm. Response to treatment can be poor.
Case report: A 39-year-old woman who presents crust covered plaques with a
central ulceration with a verrucous bed on the left infrapatellar and left gemeral
regions, 30 3 40 mm and 50 3 50 mm respectively, of 18 months evolution. A smear
of scarification material showed Leishmania spp. amastigotes; the Leishmanin test
gave a 29 3 15 mm induration and a subsequent diagnosis of localized cutaneous
Leishmaniasis was made. The patient received six courses of 20 antimonial
injections each (two ampoules per day VIM equivalent to 15 mg/kg/day) with
partial improvement due to persistence of an ulceration on the lower lateral border
of the ulcer located on the patellar region. A new biopsy reported persistence of a
granuloma by living agent and PCR was positive for Leishmania brasiliensis. The
lack of response to treatment was considered as resistance, and the patient was
given Amphotericine B, with clinical cure.

Cutaneous Mycobacterium massiliense infection of the sole

(Poster reference number 4860)

Miyoung Jung, MD, Samsung Medical Center, Seoul, South Korea; Dongyoon Lee,
MD, PhD, Samsung Medical Center, Seoul, South Korea

Discussion: Leishmania resistance to antimonials has been described in up to 80% of

visceral forms in India, and between 7% to 20% in cutaneous forms in Latin America.
In Venezuela it only corresponds to 1%. Treatment failures are associated to age,
treatment dose, Leishmania spp., and site of lesions. It has been described that
lesions localized on lower limbs, as in our case, have a poor therapeutic response.

Nontuberculous mycobacterium (NTM) are ubiquitous environmental organisms

that are progressively recognized as human pathogen. Mycobacterium massiliense
recognized as a separate species from Mycobacterium abscessus is little known
regarding clinical patterns and response to treatment. We present the case of a
localized cutaneous infection due to M massiliense of the sole associated with
acupuncture. M massiliense was identified via polymerase chain reactionerestriction fragment length polymorphism analysis. We treated the patient with single
therapy of clarithromycin for 3 months and the patient showed a significant
response to this treatment. It is relatively rare to occur on the sole in NTM cases,
especially M massiliense. M massiliense would seem to have different response
patterns to antibiotics treatments distinct from other NTM species.

Commercial support: None identified.

Commercial support: None identified.

APRIL 2012

J AM ACAD DERMATOL

AB107