1.Syphilitic unorthodoxy: A case of Lues Maligna in a human immunodeficiency virus-negative 28-year-old Filipino male
Bianca Victoria Castada Peñ ; a ; Danelle Anne Lazatin Santos ; Ma. Bianca Therese Relova‑Haresco ; Ma. Teresita Gonzales Gabriel
Journal of the Philippine Dermatological Society 2024;33(1):13-16
Lues maligna, also known as malignant syphilis, is an uncommon variant of syphilis at the secondary
stage – more commonly reported in immunocompromised patients or those with concomitant human
immunodeficiency virus (HIV) infection. In this report, we present a case of a 28‑year‑old HIV‑negative
male with a 9‑month history of multiple, well‑defined, irregularly‑shaped, erythematous papules, and small
plaques evolving to ulcerated plaques and nodules with crusts, associated with pain, pruritus, and episodes
of fever, arthralgia, and weight loss. Positive treponemal and nontreponemal tests, aided by histopathologic
findings consistent with syphilis led to the diagnosis of lues maligna. Significant improvement of lesions
was noted with 3 weekly doses of 2.4 million units of benzathine penicillin G. For patients presenting
with painful and pruritic erythematous ulcerated plaques with crusts associated with systemic symptoms,
and with a significant sexual history despite testing negative for HIV infection, a high index of suspicion
for uncommon presentations of other sexually transmitted infections such as syphilis could aid in early
diagnosis and subsequent treatment.
2.An unusual presentation of painless penile erosions of pemphigus vulgaris: A case report
Ma. Bianca Therese Relova-Haresco ; Gisella U. Adasa ; Sarah E. Nain
Journal of the Philippine Dermatological Society 2022;31(2):48-51
Introduction:
Pemphigus vulgaris is a life-threatening, autoimmune bullous disease caused by desmogleins (Dsg) 1 and 3 au-
toantibodies. It is a rare disease with an incidence rate of 0.5 to 3.2 per 100,000 per year. It typically presents as painful, flaccid
blisters and erosions on both the skin and mucous membranes.
Case report:
We present a 43-year-old male with painless penile erosions of 1-month duration. He was evaluated for sexually
transmitted infections, but laboratory tests yielded negative results. Subsequently, vesicles and bullae on the back and hyper-
keratotic lesions on the malar area appeared, leading to the differential diagnoses of bullous diseases. Skin biopsy was done
revealing intraepidermal suprabasal blisters with acantholytic cells. Direct Immunofluorescence demonstrated positive inter-
cellular deposits of IgG and C3. ELISA Dsg 1 and Dsg 3 were positive (ratio of 1.857 and 4.580, respectively). A final diagnosis of pem-
phigus vulgaris (PV) was made. The patient has remained in remission after a 3-month course of prednisone and azathioprine.
Conclusion
This is a unique case of PV presenting with an unusual manifestation of painless penile erosions. There have been
limited reports of PV with penile skin involvement and all cases presented with painful lesions. Because painless penile lesions as
presenting feature is rare, the diagnosis may be easily missed. This case demonstrates that thorough dermatologic examination
and early diagnosis despite atypical findings are crucial to provide timely and appropriate treatment as this determines the clinical
outcome of the disease.
Pemphigus
;
Desmogleins
;
Azathioprine