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  • Title: A rare case of secondary syphilis manifesting as immune reconstitution syndrome in an HIV-positive patient.
    Author: Vasudevan B, Verma R, Pragasam V, Badad A, Mitra D, Singh V.
    Journal: J Int Assoc Provid AIDS Care; 2013; 12(6):380-3. PubMed ID: 23803565.
    Abstract:
    A 44-year-old HIV-infected male, having a low CD4 count, was on antiretroviral therapy for the last 2 months, when he developed a skin rash. He gave a history of solitary unprotected extramarital sexual contact 6 months before onset of the rash. Dermatological examination revealed a bilaterally symmetrical, maculopapular erythematous rash involving the palms, forearms, and neck. He showed a positive sign of Buschke-Ollendorff. In the meanwhile, the CD4 count had improved to 196 cells/mm(3) from the previous count of 92 cells/mm(3) and the viral load had decreased. Serum venereal disease research laboratory (VDRL) test was reactor at 1:64. He was found to be positive result for treponema pallidum hemagglutination test. Skin biopsy revealed features of secondary syphilis. The rash responded well to a single injection of benzathine penicillin, resulting in the lowering of the VDRL titers. There was no evidence of neurosyphilis. This is a very rare instance of secondary syphilis manifesting as immune reconstitution syndrome in an HIV-positive patient.
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