Syphilis is well known for its protean cutaneous manifestations, which led early clinicians to christen the disease "the great imitator." Lues maligna, or nodular-ulcerative syphilis, is a rare but severe manifestation of secondary syphilis first described by Bazin in 1859, with early systematic studies by Haslund and Neisser in the late 1800s (1, 2).
Lues maligna is characterized by marked prodromal constitutional symptoms, as observed in our patient.
Lues maligna is characterized by occlusion of the blood vessels with resultant fibrinoid necrosis at the dermal-subcutaneous junction.
The prevalence of lues maligna was 0.36% in Haslund's original series (2).
Lues maligna in early HIV infection: case report and review of the literature.
Our initial evaluation centered around lues maligna
but this was excluded on the basis of the fact that lesions of lues maligna
are usually multiple, well demarcated rupioid nodules and papules.
Malignant syphilis also known as lues maligna or ulceronodular syphilis is a severe form of secondary syphilis and is more common among HIV infected persons (5).
Fisher's diagnostic criteria for lues maligna include strongly positive RPR titre, a severe Jarisch-Herxheimer reaction, characteristic gross and microscopic morphology and rapid resolution of the lesions with antibiotics (7).
Lues maligna. Presentation of a cas and a review of the literature.
(9.) Tucker, J.D., et al., Lues maligna in early HIV infection case report and review of the literature.
Perforation of hard palate in lues maligna
associated with HIV infection.