Challenges in Treating Secondary Syphilis Osteitis in an Immunocompromised Patient with a Penicillin Allergy: Case Report and Review of the Literature
Syphilis is a sexually transmitted infection that remains fairly commonplace. The introduction of penicillin aided in curbing the incidence of disease; however, with the advent of the human immunodeficiency virus (HIV), syphilis is now on a resurgence with sometimes curious presentations. We present...
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| Format: | Article |
| Language: | English |
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Wiley
2016-01-01
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| Series: | Case Reports in Infectious Diseases |
| Online Access: | http://dx.doi.org/10.1155/2016/4983504 |
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| author | Robert Ali Julio Perez-Downes Firas Baidoun Bashar Al Turk Carmen Isache Girish Mohan Charles Perniciaro |
| author_facet | Robert Ali Julio Perez-Downes Firas Baidoun Bashar Al Turk Carmen Isache Girish Mohan Charles Perniciaro |
| author_sort | Robert Ali |
| collection | DOAJ |
| description | Syphilis is a sexually transmitted infection that remains fairly commonplace. The introduction of penicillin aided in curbing the incidence of disease; however, with the advent of the human immunodeficiency virus (HIV), syphilis is now on a resurgence with sometimes curious presentations. We present a case of a 36-year-old Caucasian gentleman with untreated HIV who complained of a skin eruption and joint pains for 6 weeks, prompting the diagnosis of secondary syphilis osteitis. Skin lesions were reminiscent of “malignant” syphilis. CD4 count was 57 cells/μL. RPR was elevated with 1 : 64 titer and positive confirmatory TP-PA. Radiography of the limbs revealed polyostotic cortical irregularities corroborated on bone scintigraphy. The patient had an unknown penicillin allergy and was unwilling to conduct a trial of penicillin-based therapy. He was subsequently treated with doxycycline 100 mg twice daily for 6 weeks and commenced antiretroviral therapy, noting dramatic improvement in both the skin lesions and joint pains. Unfortunately, he defaulted on follow-up, precluding serial RPR and bone imaging. Penicillin allergies have proven to be quite a conundrum in such patients, without much recourse for alternative therapy. Doxycycline with/without azithromycin is other options worth considering. |
| format | Article |
| id | doaj-art-51c1f2dfc58c49f1a8520160eaf4e975 |
| institution | OA Journals |
| issn | 2090-6625 2090-6633 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Infectious Diseases |
| spelling | doaj-art-51c1f2dfc58c49f1a8520160eaf4e9752025-08-20T02:05:39ZengWileyCase Reports in Infectious Diseases2090-66252090-66332016-01-01201610.1155/2016/49835044983504Challenges in Treating Secondary Syphilis Osteitis in an Immunocompromised Patient with a Penicillin Allergy: Case Report and Review of the LiteratureRobert Ali0Julio Perez-Downes1Firas Baidoun2Bashar Al Turk3Carmen Isache4Girish Mohan5Charles Perniciaro6Department of Internal Medicine, University of Florida-Jacksonville, 655 W 8th Street, Jacksonville, FL 32209, USADepartment of Internal Medicine, University of Florida-Jacksonville, 655 W 8th Street, Jacksonville, FL 32209, USADepartment of Internal Medicine, University of Florida-Jacksonville, 655 W 8th Street, Jacksonville, FL 32209, USADepartment of Internal Medicine, University of Florida-Jacksonville, 655 W 8th Street, Jacksonville, FL 32209, USADepartment of Internal Medicine, University of Florida-Jacksonville, 655 W 8th Street, Jacksonville, FL 32209, USADepartment of Pathology, University of Florida-Jacksonville, 655 W 8th Street, Jacksonville, FL 32209, USADepartment of Pathology, University of Florida-Jacksonville, 655 W 8th Street, Jacksonville, FL 32209, USASyphilis is a sexually transmitted infection that remains fairly commonplace. The introduction of penicillin aided in curbing the incidence of disease; however, with the advent of the human immunodeficiency virus (HIV), syphilis is now on a resurgence with sometimes curious presentations. We present a case of a 36-year-old Caucasian gentleman with untreated HIV who complained of a skin eruption and joint pains for 6 weeks, prompting the diagnosis of secondary syphilis osteitis. Skin lesions were reminiscent of “malignant” syphilis. CD4 count was 57 cells/μL. RPR was elevated with 1 : 64 titer and positive confirmatory TP-PA. Radiography of the limbs revealed polyostotic cortical irregularities corroborated on bone scintigraphy. The patient had an unknown penicillin allergy and was unwilling to conduct a trial of penicillin-based therapy. He was subsequently treated with doxycycline 100 mg twice daily for 6 weeks and commenced antiretroviral therapy, noting dramatic improvement in both the skin lesions and joint pains. Unfortunately, he defaulted on follow-up, precluding serial RPR and bone imaging. Penicillin allergies have proven to be quite a conundrum in such patients, without much recourse for alternative therapy. Doxycycline with/without azithromycin is other options worth considering.http://dx.doi.org/10.1155/2016/4983504 |
| spellingShingle | Robert Ali Julio Perez-Downes Firas Baidoun Bashar Al Turk Carmen Isache Girish Mohan Charles Perniciaro Challenges in Treating Secondary Syphilis Osteitis in an Immunocompromised Patient with a Penicillin Allergy: Case Report and Review of the Literature Case Reports in Infectious Diseases |
| title | Challenges in Treating Secondary Syphilis Osteitis in an Immunocompromised Patient with a Penicillin Allergy: Case Report and Review of the Literature |
| title_full | Challenges in Treating Secondary Syphilis Osteitis in an Immunocompromised Patient with a Penicillin Allergy: Case Report and Review of the Literature |
| title_fullStr | Challenges in Treating Secondary Syphilis Osteitis in an Immunocompromised Patient with a Penicillin Allergy: Case Report and Review of the Literature |
| title_full_unstemmed | Challenges in Treating Secondary Syphilis Osteitis in an Immunocompromised Patient with a Penicillin Allergy: Case Report and Review of the Literature |
| title_short | Challenges in Treating Secondary Syphilis Osteitis in an Immunocompromised Patient with a Penicillin Allergy: Case Report and Review of the Literature |
| title_sort | challenges in treating secondary syphilis osteitis in an immunocompromised patient with a penicillin allergy case report and review of the literature |
| url | http://dx.doi.org/10.1155/2016/4983504 |
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