Posters
Presentation Type
Poster
Discipline Track
Patient Care
Abstract Type
Case Report
Abstract
Background: Syphilis is a sexually transmitted infection that has been increasing in the United States. The prevalence of syphilis rose by 6.8% during 2019-to 2020. Secondary syphilis typically presents with a generalized maculopapular rash on palms and soles, however, can also have subtle dermatological findings such as alopecia. Syphilitic alopecia is an atypical manifestation of secondary syphilis, seen in 2.9 to 7% of the cases.
Case presentation: An 18-year-old Hispanic male presented to the clinic after noticing patchy loss of hair on the scalp for 2 weeks and one week of generalized non pruritic rash. His past medical history was unremarkable and there was no history of allergies. He denied alcohol, tobacco or illicit drug use. He reported having multiple sexual encounters with unknown female partners and denied consistent use of condoms. He also denied previous history of genial lesions or ulcerations. Physical examination revealed alopecia as a moth-eaten pattern on parietal, temporal and occipital regions of the scalp. Further exam revealed symmetric macular-papular eruptions involving the trunk and the extremities, faint papular lesions on the soles but the palms were spared. Laboratory analysis revealed positive VDRL (1:156), reactive FTA-ABS and negative HIV serology. He was treated with penicillin G benzathine 2.4 million units for secondary syphilis, resulting in resolution of syphilitic alopecia and the rash.
Conclusion: Secondary syphilis occurs in 25 % of patients with untreated primary syphilis infection. Primary infection could be asymptomatic or gone unnoticed as the ulcer is generally painless and heals spontaneously. Our patient presented with alopecia followed by generalized macular papular eruption. He was diagnosed and treated for secondary syphilis. Syphilitic alopecia is an uncommon manifestation and occurs as a non-cicatricial alopecia in 2.9% of cases. The presentation is subtle and might be underdiagnosed. It may present as patchy alopecia in a moth-eaten pattern, diffuse alopecia or mixed form. Syphilitic alopecia can also involve eyebrows, or beard, not seen in our case. Generally, alopecia improves with treatment of syphilis. Syphilitic alopecia should be considered in the differential diagnosis of alopecia in a patient with high-risk sexual behavior.
Academic/Professional Position
Resident
Academic/Professional Position (Other)
PGY2
Mentor/PI Department
Internal Medicine
Recommended Citation
Zamudio Herrera, Oscar Rodrigo and Varghese, Nevin, "Patchy alopecia in a young adult with a generalized rash" (2023). Research Symposium. 85.
https://scholarworks.utrgv.edu/somrs/2022/posters/85
Patchy alopecia in a young adult with a generalized rash
Background: Syphilis is a sexually transmitted infection that has been increasing in the United States. The prevalence of syphilis rose by 6.8% during 2019-to 2020. Secondary syphilis typically presents with a generalized maculopapular rash on palms and soles, however, can also have subtle dermatological findings such as alopecia. Syphilitic alopecia is an atypical manifestation of secondary syphilis, seen in 2.9 to 7% of the cases.
Case presentation: An 18-year-old Hispanic male presented to the clinic after noticing patchy loss of hair on the scalp for 2 weeks and one week of generalized non pruritic rash. His past medical history was unremarkable and there was no history of allergies. He denied alcohol, tobacco or illicit drug use. He reported having multiple sexual encounters with unknown female partners and denied consistent use of condoms. He also denied previous history of genial lesions or ulcerations. Physical examination revealed alopecia as a moth-eaten pattern on parietal, temporal and occipital regions of the scalp. Further exam revealed symmetric macular-papular eruptions involving the trunk and the extremities, faint papular lesions on the soles but the palms were spared. Laboratory analysis revealed positive VDRL (1:156), reactive FTA-ABS and negative HIV serology. He was treated with penicillin G benzathine 2.4 million units for secondary syphilis, resulting in resolution of syphilitic alopecia and the rash.
Conclusion: Secondary syphilis occurs in 25 % of patients with untreated primary syphilis infection. Primary infection could be asymptomatic or gone unnoticed as the ulcer is generally painless and heals spontaneously. Our patient presented with alopecia followed by generalized macular papular eruption. He was diagnosed and treated for secondary syphilis. Syphilitic alopecia is an uncommon manifestation and occurs as a non-cicatricial alopecia in 2.9% of cases. The presentation is subtle and might be underdiagnosed. It may present as patchy alopecia in a moth-eaten pattern, diffuse alopecia or mixed form. Syphilitic alopecia can also involve eyebrows, or beard, not seen in our case. Generally, alopecia improves with treatment of syphilis. Syphilitic alopecia should be considered in the differential diagnosis of alopecia in a patient with high-risk sexual behavior.