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Volume 8, Issue 4

Secondary syphilis in human immunodeficiency virus coinfection: a case report of an atypical presentation with cutaneous and neurological involvement Open Access

Abstract

Syphilis remains a diagnostic challenge due to its wide range of clinical manifestations, particularly in immunocompromised patients. Secondary syphilis may present with atypical cutaneous and neurological features, complicating timely recognition and management. High clinical suspicion is essential in such scenarios.

We describe the case of a 62-year-old man with a 6-month history of palmoplantar keratoderma, nail dystrophy, bilateral hearing loss and symmetrical proximal myopathy of the lower limbs. A comprehensive diagnostic approach, including clinical, histopathological, serological and cerebrospinal fluid (CSF) analyses, was undertaken. Skin biopsy revealed vacuolar interface dermatitis with a superficial perivascular inflammatory infiltrate, and immunohistochemistry confirmed the presence of spirochetes. Serological tests were positive for , and newly diagnosed human immunodeficiency virus (HIV) coinfection was identified. Despite a negative CSF Venereal Disease Research Laboratory (VDRL), the presence of pleocytosis, elevated protein concentration and hypoglycorrhachia supported a diagnosis of probable neurosyphilis. The patient was treated with intravenous crystalline penicillin G and initiated on antiretroviral therapy, resulting in full resolution of cutaneous and neurological symptoms.

This case underscores the polymorphic nature of syphilis in immunocompromised individuals, particularly those with HIV infection. Clinicians should maintain a high index of suspicion for neurosyphilis even when CSF VDRL results are negative, provided that clinical and laboratory findings are supportive. Early diagnosis and appropriate treatment are critical for favourable outcomes.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): human immunodeficiency virus (HIV) , neurosyphilis , palmoplantar keratoderma , secondary syphilis , syphilis case report and syphilitic onychopathy
© 2026 The Authors
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License. This article was made open access via a Publish and Read agreement between the Microbiology Society and the corresponding author’s institution.
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2026-04-20
2026-04-20

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/content/journal/acmi/10.1099/acmi.0.001086.v3
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Secondary syphilis in human immunodeficiency virus coinfection: a case report of an atypical presentation with cutaneous and neurological involvement
Access Microbiology 8, 001086.v3 (2026); https://doi.org/10.1099/acmi.0.001086.v3
/content/journal/acmi/10.1099/acmi.0.001086.v3
/content/journal/acmi/10.1099/acmi.0.001086.v3
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