# Mucocutaneous relapse during late latent syphilis as initial presentation of HIV infection

## TL;DR

A patient with late latent syphilis experienced mucocutaneous relapse and was later diagnosed with HIV, highlighting unusual disease progression in HIV-positive individuals.

## Contribution

Reports an atypical case linking mucocutaneous relapse in late latent syphilis with initial HIV diagnosis.

## Key findings

- Late latent syphilis can present with mucocutaneous relapse in HIV-positive individuals.
- Syphilis may follow an atypical clinical course in people living with HIV.
- Successful treatment of syphilis was achieved with benzathine penicillin in this case.

## Abstract

Syphilis is a re-emerging sexually transmitted infection. According to the definition, latent syphilis is characterized by seroreactivity without clinical manifestations. Here, we reported an atypical case of syphilis in a patient with HIV naïve to the antiretroviral treatment characterized by mucocutaneous relapse that occurred in the late latent stage. The patient reported his last sexual intercourse about 18 months ago and had self-healing genital and palmoplantar lesions more than 1 year before the presentation. He denied any other types of sexual relationship. He presented with mucocutaneous scattered lesions on his face, neck, palms, soles, penis, and scrotum. He was compliant with arthralgias, myalgias, asthenia, new onset stypsis, and mild anorectal pain. Testing for Syphilis and HIV returned positive. Opportunistic infections were excluded, and antiretroviral therapy with a bictegravir-based regimen was started. Syphilis was treated successfully with three doses of 2.4 million units of benzathine penicillin.

●Syphilis is a re-emerging disease.●Late latent syphilis may be rarely associated with mucocutaneous relapses.●Syphilis may have an atypical course in PLWH.

Syphilis is a re-emerging disease.

Late latent syphilis may be rarely associated with mucocutaneous relapses.

Syphilis may have an atypical course in PLWH.