Images in Clinical Medicine
Condylomata Lata of Secondary Syphilis
N Engl J Med 2005; 352:708February 17, 2005
- Article
A 34-year old bisexual man with newly diagnosed human immunodeficiency virus type 1 (HIV-1) infection presented with a one-month history of anal and oral lesions. He recalled having had a lesion on the foreskin of his penis three months previously; it had cleared spontaneously. Physical examination revealed the warty, mucoid, plaque-like perianal lesions of condylomata lata as well as “snail-track” ulcerations in the mouth and on the lips and tongue. Generalized lymphadenopathy was present, but the patient had no rash, constitutional symptoms, or headache. The CD4 cell count was 437 per cubic millimeter, and the plasma HIV-1 viral load was 64,600 copies per milliliter. Titers of Treponema pallidum were greater than 1:5120 on hemagglutination assay, and a fluorescent treponemal antibody absorption test was positive. Examination of the cerebrospinal fluid revealed aseptic meningitis, with 64 cells (predominantly mononuclear) per cubic millimeter and a nonreactive result on a Venereal Disease Research Laboratory test. After 14 days of treatment with intravenous penicillin G (24 million U per day), resolution of the oral and perianal lesions was observed.
Josip Begovac, M.D., Ph.D.
Davorka Lukas, M.D., Ph.D.
University Hospital for Infectious Diseases, 10 000 Zagreb, Croatia
