Kevin H Nguyen, Christopher M Wong, Ethan Q Nguyen
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Histologically, actinic elastosis surrounds the outer annulus ring, with histiocytes and giant cells within the raised border, and the innermost central zone is filled with minimal to absent elastic fibers.</p><p><strong>Case presentation: </strong>We present a middle-aged female with a pruritic eruption of diffuse erythematous macules and papules coalescing into plaques with mild scale involving the scalp, face, neck, torso, and upper and lower extremities, including the palms and soles, but sparing the ears, bilateral axillae, elbows, and knees. Skin biopsies revealed solar elastosis and abundant multinucleated foreign body giant cells with ingested elastic fibers. The patient's clinical presentation and histopathology were consistent with a diagnosis of AG. Furthermore, spirochete immunostaining of the specimens revealed multiple <i>Treponema pallidum</i> spirochetes throughout the epidermis and dermis. Secondary syphilis with primary chancre was added to the diagnosis. Treatment included oral and topical steroids followed by intravenous penicillin G. After 1 month, all lesions had resolved with post-inflammatory erythema.</p><p><strong>Conclusion: </strong>Our patient differs from the typical presentation in describing intense pruritus with her eruption. This interesting collision reminds clinicians to retain a high index of suspicion for multiple diagnoses in a single patient.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"5 2","pages":"165-169"},"PeriodicalIF":0.0000,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11229604/pdf/","citationCount":"0","resultStr":"{\"title\":\"Actinic Granuloma Complicated by Secondary Syphilis: A Case Report.\",\"authors\":\"Kevin H Nguyen, Christopher M Wong, Ethan Q Nguyen\",\"doi\":\"10.36518/2689-0216.1636\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Actinic granuloma (AG) is a rare skin eruption thought to result from a sun-induced inflammatory response attracting giant cells, which are large, multinucleated, and inflammatory, to form granulomas and degrade surrounding elastic material. 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Furthermore, spirochete immunostaining of the specimens revealed multiple <i>Treponema pallidum</i> spirochetes throughout the epidermis and dermis. Secondary syphilis with primary chancre was added to the diagnosis. Treatment included oral and topical steroids followed by intravenous penicillin G. After 1 month, all lesions had resolved with post-inflammatory erythema.</p><p><strong>Conclusion: </strong>Our patient differs from the typical presentation in describing intense pruritus with her eruption. 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引用次数: 0
摘要
简介日光性肉芽肿(AG)是一种罕见的皮肤疹,被认为是由日光引起的炎症反应导致的,这种炎症反应吸引巨细胞形成肉芽肿,并使周围的弹性物质降解。临床上,皮损始于暴露在阳光下的皮肤,表现为粉红色丘疹和结节,然后凝聚成有色素沉着中心的分界环状斑块。组织学上,放线弹性病变围绕着环状外圈,凸起的边界内有组织细胞和巨细胞,最内侧的中央区充满了极少甚至没有的弹性纤维:患者为一名中年女性,头皮、面部、颈部、躯干、上肢和下肢(包括手掌和足底)出现弥漫性红斑、丘疹和斑块,伴有轻度鳞屑。皮肤活组织检查发现了日光性弹性增生和大量多核异物巨细胞,并伴有被吞噬的弹性纤维。患者的临床表现和组织病理学与 AG 诊断一致。此外,标本的螺旋体免疫染色显示,表皮和真皮中存在多个苍白螺旋体。继发性梅毒合并原发性软下疳的诊断结果被添加到诊断中。治疗包括口服和外用类固醇激素,然后静脉注射青霉素 G。一个月后,所有皮损均消退,并出现炎症后红斑:结论:我们的病人与典型的表现不同,她的疹子伴有强烈的瘙痒。这一有趣的碰撞提醒临床医生要对单个患者的多种诊断保持高度怀疑。
Actinic Granuloma Complicated by Secondary Syphilis: A Case Report.
Introduction: Actinic granuloma (AG) is a rare skin eruption thought to result from a sun-induced inflammatory response attracting giant cells, which are large, multinucleated, and inflammatory, to form granulomas and degrade surrounding elastic material. Clinically, lesions begin on sun-exposed skin as pink papules and nodules that coalesce into demarcated annular plaques with a hypopigmented center. Histologically, actinic elastosis surrounds the outer annulus ring, with histiocytes and giant cells within the raised border, and the innermost central zone is filled with minimal to absent elastic fibers.
Case presentation: We present a middle-aged female with a pruritic eruption of diffuse erythematous macules and papules coalescing into plaques with mild scale involving the scalp, face, neck, torso, and upper and lower extremities, including the palms and soles, but sparing the ears, bilateral axillae, elbows, and knees. Skin biopsies revealed solar elastosis and abundant multinucleated foreign body giant cells with ingested elastic fibers. The patient's clinical presentation and histopathology were consistent with a diagnosis of AG. Furthermore, spirochete immunostaining of the specimens revealed multiple Treponema pallidum spirochetes throughout the epidermis and dermis. Secondary syphilis with primary chancre was added to the diagnosis. Treatment included oral and topical steroids followed by intravenous penicillin G. After 1 month, all lesions had resolved with post-inflammatory erythema.
Conclusion: Our patient differs from the typical presentation in describing intense pruritus with her eruption. This interesting collision reminds clinicians to retain a high index of suspicion for multiple diagnoses in a single patient.