Generalized Condyloma Latum;a Case Report And Literature Review

Background: Syphilis is a sexually transmitted disease caused by pallidum Treponema infection,which even can invade all organs of the body.Condyloma latum is a kind of rare syphilitic rash,which transmitted by treponema pallidum through local lymph into the blood.It is called the characteristic rash of secondary syphilis.Case with widespread lessions is more rare.In recent years,with the elevated incidence rate of syphilis,the morphological diversity of syphilis and rare rash also increased,and the misdiagnosis rate is higher.This disease needs to be differentiated with genital warts,,skin cancer,deep skin fungal diseases,warty skin tuberculosis and other diseases.This essay reports one special case that the patient concealed his medical history with the signs of almost whole body making the disease lacks of first phrase clinical manifestations.Meanwhile,this article also gives a brief summary about the relevant disease literature,the progress in diagnosis and treatment methods,as well as the author's ideas.Case presentation: Basic information about the patient: Gender: Male,Nationality: Han,Marital Status: Divorced.Symptom Description: "umbilical region and external genitals making without specific symptom for one month." One month ago,soybean sized flat papules appeared in the patient's urethral without obvious cause,within a few days flat papules grow into bean size covered with little yellowish white purulent secretion,without obvious itching.Untreated,the rash gradually increased both in number and size,and extends to trunk,umbilicus.Before coming to dermatology clinic of the first affiliated hospital of Dalian medical university for further diagnosis and treatment,the patient once bought antibiotics ointment for external use by himself,and the rash had no obvious regression.Patient without the symptoms of chill,fever,hair loss and nail damage.The state of mind and spirit is clear,diet and sleep is normal,defecations are as usual and no significant changes in body weight.The previous body health of the patient is normal without food and drug allergy history,as well as no similar family history.Diffuse plasma cell infiltration in the superficial dermis,which is consistent with the condyloma latum.Physical examination: general situation of the patient is normal,and the system examination showed no apparent abnormalities,superficial lymph nodes were not referred,liver and spleen both are normal without swelling.Specialist examination: torso,navel,penis,scrotum,perianal area scattered skin or light red soybean size flat papules,plaques,mass,no tenderness;Lesions on the penis and perianal covered light yellow purulent secretions.Pathological biopsy showed epidermis irregular hyperplasia hypertrophy with superficial crust,intracellular and intercellular edema,lymphocytes and neutrophils infiltration.Laboratory examination: rapid plasma ring card test(RPR)(+positive),the titer of RPR is 1:64,anti-TP is positive,anti HIV antibody is negative.Combined with clinical,histopathological and laboratory examination,the patient is diagnosed as the second phase of syphilis(condyloma latum).Treatment: When penicillin skin test showed negative,the patient was given intramuscular injection of benzathine benzylpenicillin 2.4 million U every week,and this process lasts for 3 weeks.After one week's treatment,all the rash was significantly reduced as well as the secretions.One month after the completion of treatment,the patient described during the telephone interview that all the skin rash subsided and some light brown pigmentation left.Conclusions: The patient claimed that he didn't have syphilitic chancre,so the first manifestation is urethra condyloma latum within many parts of the body,this case is regarded as a special case lack of first phase syphilis clinical manifestations.And the patient hid the medical history,and regarded umbilical region and external ginatal swollen without specific symptom for one month as chief signs.It is prone to misdiagnose.This case showed that syphilis incidence increased gradually in recent years,and the clinical manifestations of syphilis no longer constrained by the traditional expression form,especially the morphological diversity of syphilis and incidence have a significant change compared to the previous situation.Rare rash gradually increased,and the disease can't be explained with the general case,therefore,it is important that the clinical doctor should ask the medical history carefully,process system physical examination,and improve the relevant laboratory tests in order to confirm the diagnosis and avoid missed diagnose or misdiagnose.These methods could prevent the further spread of disease,including the development of the disease of late syphilis and lead to more serious consequences.Meanwhile,this report further summarizes the precautions in the clinical diagnosis,elaborates the differential diagnosis and treatment of diseases,and evaluates the advantages and disadvantages of the various treatment methods of the disease.The author also reviews many relevant literatures so that to make a comparison and conclusion about the recurrence rate after the treatment.