Syphilis is a Rare Cause of Erythema Nodosum: A Case Report

Figures & data

Figure 1 Clinical and pathology examination of skin lesions presented by the patient. (A) Maculopapular rash on the lower limbs with Biett collarette; (B) erythema nodosum on the right forearm; (C) granulomatous dermatitis with a lichenoid infiltrate; (D) septal panniculitis.

Table 1 Case Reports of Erythema Nodosum Associated with Syphilis

First Author, Year	Sex/Age	History	Laboratory	Treatment and Clinical Evolution
A Alinovi, 1983^Citation3	Male/28	The patient was admitted for: - A general rash of 15 days’ duration - A recent onset of several tender, painful nodules on the upper and lower limbs - associated symptoms: fever, arthralgia, sore throat	● Erythrocyte sedimentation rate 43.5 ● Allele-specific oligonucleotide 15O ● Negative protein C reactive ● Tine test: 1 + ● VDRL 1/32 ● TPHA 1/5I2 ● Positive FTA-abs ● Negative dark-field examination of palmar lesions and the pretibial nodular lesions ● Isolation of group B Beta-hemolytic streptococci and alpha-hemolytic streptococci on throat culture ● No hilar adenopathy or lung alterations on chest X-ray	● Administration of 1.2 MU, IM of a penicillin preparation at three-day intervals for a total dose of 12 MU ● Recovery of the EN lesions occurred within 3 weeks
T J Silber, 1987^Citation4	Female/15	She presented with:  - hot, painful, shiny, red nodules on the anterior surface of both shins, having developed over two weeks  -no fever  -no sore throat	● Normal hemogram ● negative throat culture for A beta hemolytic Streptococcus ● Negative tine test ● Normal chest roentgenogram ● Negative cervical cultures for Neisseria gonorrhoea, Chlamydia trachomatis, Gardnerella vaginalis. ● Positive rapid plasma reagin ● Positive fluorescent treponemal antibody-absorption test	● Administration of 2.4×10^6 units of benzathine penicillin ● Start of lesions regression a few weeks after treatment
MP Frishman, 1975^Citation5	Data not accessible
L Guggenheim, 1959^Citation6	Data not accessible

Abbreviations: VDRL, Venereal Disease Research Laboratory; TPHA, Test for Determination of Treponema pallidum Antibodies; FTA, Fluorescent Treponemal Antibody; EN, Erythema Nodosum; MU, Million Units; IM, intramuscular.

Alinovi A, Lui P, Benoldi D. Syphilis–still a cause of erythema nodosum. Int J Dermatol. 1983;22:310–311. doi:10.1111/j.1365-4362.1983.tb02145.x

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Silber TJ, Kastrinakis M, Taube O. Painful red leg nodules and syphilis: a consideration in patients with erythema nodosum-like illness. Sex Transm Dis. 1987;14:52–53. doi:10.1097/00007435-198701000-00012

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Frishman MP, Smetanin IV. [Case of erythema nodosum in a female patient with secondary recent syphilis]. Vrach Delo. 1975;6:115–116. Russian.

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Guggenheim L. [Erythema nodosum in primary syphilis]. Dermatologica. 1959;118:311–313. German.

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