Erythroderma-like secondary syphilis in an immunocompetent patient: case management experience

Vasenova V.Yu., Tsygankova E.I., Petunina V.V., Fedorova M.V., Potapova S.V., Zhukovsky R.O., Khamaganova I.V., Radionova E.E.

1) Pirogov Russian National Research Medical University (Pirogov University), Moscow, Russia; 2) Moscow Scientific and Practical Center for Dermatovenereology and Cosmetology, Moscow Department of Health, Moscow, Russia

Syphilis remains one of the most socially significant infections, but atypical secondary forms often lead to diagnostic errors and significant delays in specific therapy. This article presents a clinical case of a 33-year-old female patient with comorbid schizophrenia who presented with a widespread rash clinically mimicking erythroderma. At the initial outpatient presentation, the differential diagnosis included eczema and psoriasis, and topical glucocorticosteroid therapy was administered without significant benefit. Serological testing confirmed secondary syphilis, but a standard course of ceftriaxone did not provide complete resolution of the skin manifestations and was accompanied by a paradoxical increase in nontreponemal test titers. Morphological verification of the diagnosis required a biopsy, which revealed a characteristic perivascular lymphoplasmacytic infiltrate with a predominance of plasma cells. Active neurosyphilis was excluded by lumbar puncture and cerebrospinal fluid analysis. Specific signs, including Pinkus’s sign, were also noted, raising suspicion for a syphilitic etiology. The diagnosis was clarified as malignant secondary syphilis. Treatment adjustments, including a 28-day course of benzylpenicillin, resulted in significant clinical improvement. This case demonstrates the need for increased suspicion for syphilis in generalized dermatoses, particularly in patients with psychiatric comorbidity, who are more likely to experience torpid forms of infection. A comprehensive diagnostic approach, including biopsy if necessary, and adequate etiotropic therapy ensure a favorable prognosis and prevent the disease from progressing to late stages, reducing overall epidemiological risks. 

For citations: Vasenova V.Yu., Tsygankova E.I., Petunina V.V., Fedorova M.V., Potapova S.V., Zhukovsky R.O., Khamaganova I.V., Radionova E.E. Erythroderma-like secondary syphilis in an immunocompetent patient: case management experience. Pharmateca. 2026;33(5):162-168. (In Russ.). DOI: https://dx.doi.org/10.18565/pharmateca.2026.5.162-168

Authors’ contribution: Study concept and design – V.Yu. Vasenova, V.V. Petunina. Material collection and processing – M.V. Fedorova, S.V. Potapova, E.E. Radionova. Writing – E.I. Tsygankova, R.O. Zhukovsky. Editing and approval of the text – V.Yu. Vasenova, V.V. Petunina.
Conflicts of interest: The authors confirm that they have no conflicts of interest to declare.
Funding: The study was conducted without any sponsorship.
Patient Consent for Publication: The patients provided an informed consent for the publication of their data.

Keywords

About the Authors

Viktoria Yu. Vasenova, Dr. Sci. (Med.), Professor, Department of Skin Diseases and Cosmetology, Institute of Continuous Education and Professional Development, Pirogov Russian National Research Medical University (Pirogov University); Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow Healthcare Department, Moscow, Russia; vasenova@mail.ru, ORCID: https://orcid.org/0000-0002-6090-9676
Ekaterina I. Tsygankova, Teaching Assistant at the Department of Skin Diseases and Cosmetology, Institute of Continuous Education and Professional Development, Pirogov Russian National Research Medical University (Pirogov University); Dermatovenerologist, Branch of Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow Healthcare Department, Moscow, Russia; katrin0195@yandex.ru, ORCID:
https://orcid.org/0000-0002-2768-8322 (corresponding author)
Valentina V. Petunina, Cand. Sci. (Med.), Associate Professor, Department of Skin Diseases and Cosmetology, Institute of Continuous Education and Professional Development, Pirogov Russian National Research Medical University (Pirogov University); Moscow Scientific and Practical Center for Dermatovenereology and Cosmetology, Moscow Healthcare Department, Moscow, Russia; v.v.petounina@mail.ru, ORCID: https://orcid.org/0000-0002-3808-8584
Maria V. Fedorova, Dermatovenerologist, Branch of Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow Healthcare Department, Moscow, Russia; maria.fedorova71@gmail.com, ORCID: https://orcid.org/0009-0006-3519-2411
Svetlana V. Potapova, Dermatovenereologist, Head of the Dermatovenereology Department No. 1, Branch of the Moscow Scientific and Practical Center for Dermatovenereology and Cosmetology, Moscow Healthcare Department, Moscow, Russia; vajoli@mail.ru, ORCID: https://orcid.org/0000-0002-2444-2802
Rostislav O. Zhukovsky, Head of the Branch of Moscow Scientific and Practical Center for Dermatovenereology and Cosmetology, Moscow Healthcare Department, Moscow, Russia; zhukovskiy-ro@rudn.ru, ORCID: https://orcid.org/0000-0001-7958-9660
Irina V. Khamaganova, Dr. Sci. (Med.), Professor, Department of Skin Diseases and Cosmetology, Institute of Continuous Education and Professional Development, Pirogov Russian National Research Medical University (Pirogov University), Moscow, Russia, irina.khamaganova@gmail.com, ORCID: https://orcid.org/0000-0003-2942-8812
Ekaterina E. Radionova, Cand. Sci. (Med.), Head of Department No. 0904, Moscow Scientific and Practical Center for Dermatovenereology and Cosmetology, Moscow Healthcare Department, Moscow, Russia; radionova.ekat@yandex.ru, ORCID: https://orcid.org/0000-0002-2642-9126

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