Tertiary syphilis of the face

Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum. It develops in three stages, with the formation of skin lesions and enlargement of lymph nodes in the primary stage. Further development of skin lesions, the onset of systemic symptoms such as headache, fever, and malaise, and enlargement and hardening of the lymph nodes occur in the secondary stage. The heart, blood vessels, and central nervous system become involved in the tertiary stage. Late benign syphilis occurs in 17 percent of patients; cardiovascular syphilis in 10 percent; and neurosyphilis, or syphilis affecting the nervous system, in 8 percent. Late benign syphilis frequently involves the skin and bones and rarely affects the mucous membranes, muscle, abdominal organs, and eye structures. The skin lesions in late benign syphilis can be grouped into two types: the superficial noduloulcerative form, characterized by the formation of node-like lesions and ulcers; and the more damaging gummatous form, which is characterized by the formation of soft, granular tumors. A case is described of a 57-year-old woman with noduloulcerative late benign syphilis of the face with unusual features. The patient was not diagnosed with syphilis for 30 years. When treated with penicillin, she developed a low-grade fever, headache, and chills with worsening of the lesions. This reaction is commonly observed in the treatment of early syphilis. Although most of the facial lesions resolved after penicillin treatment, several granular tumors persisted, suggesting the persistence of the infecting spirochete. However, tests for T. pallidum were negative, and the lesions may result from a hypersensitivity reaction to the drug triamcinolone, which was injected directly into the lesions. (Consumer Summary produced by Reliance Medical Information, Inc.)