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Correspondence |

A Case of “Syphilis Panniculitis ” Caused by Direct Fat Inoculation by Treponema pallidum

Alisha N. Plotner, MD; Diya F. Mutasim, MD
Arch Dermatol. 2012;148(2):269-270. doi:10.1001/archdermatol.2011.2463.
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Since 2000, there has been a steady increase in the incidence of syphilis in the United States.1 In 2009, 13  997 cases of primary and secondary syphilis were reported, with an incidence rate of 4.6 cases per 100  000 persons.1 In light of this epidemic, the highly treatable nature of the disease, and the potential for serious sequelae if it is left untreated, recognition of the varied cutaneous manifestations of syphilis is critical. A case of secondary syphilis presenting with lesions of panniculitis on the legs is herein described.

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Figure 1. On the left lower leg, several 1- to 3-cm hyperpigmented nodules were found. The nodules were freely mobile over the fascia at the depth of the subcutaneous fat. The arrows indicate 2 nodules.

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Figure 2. Histopathologic evaluation. A, Low magnification of the incisional biopsy specimen reveals a lobular subcutaneous infiltrate; epidermis and dermis are unremarkable (hematoxylin-eosin, original magnification ×20). B, The subcutaneous fat reveals a moderate lobular infiltrate of lymphocytes and plasma cells with lobular fat degeneration (hematoxylin-eosin, original magnification ×40). C, Higher magnification reveals numerous lipophages, lymphocytes, and plasma cells surrounding the adipocytes (hematoxylin-eosin, original magnification ×100). D, Immunohistochemical analysis reveals the Treponema pallidum spirochetes (anti – T pallidum antibody, original magnification ×400).




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