# Lues maligna in a patient living with HIV: A case report

## TL;DR

A 25-year-old HIV-positive man with rare malignant syphilis showed full recovery after being treated with ceftriaxone due to penicillin unavailability.

## Contribution

This case report adds to the limited literature on malignant syphilis in HIV patients and highlights successful treatment with ceftriaxone.

## Key findings

- The patient showed complete improvement of skin lesions after four days of ceftriaxone treatment.
- Malignant syphilis should be considered in the differential diagnosis for nodulo-ulcerative lesions in HIV patients.
- Ceftriaxone is a viable alternative when penicillin is unavailable, with good outcomes reported in literature.

## Abstract

Malignant syphilis is a rare form of secondary syphilis that occurs mainly in patients living with human immunodeficiency virus (HIV), with approximately 15 cases reported in the last century. We present the case of a patient treated in our institution.

A 25-year-old male patient presented with round lesions in the form of ulcerations with blackish crust on the plantar area and inner edge of the right foot. VDRL (venereal disease research laboratory) test and ELISA (enzyme-linked immunosorbent assay) were performed for the diagnosis of syphilis and HIV, respectively, which were positive. Subsequently, the patient was hospitalized, and ceftriaxone was indicated due to the lack of crystalline penicillin G in the hospital. Four days later, he had complete improvement of the skin lesions. The patient is currently stable and has no recurrence of skin lesions.

Due to the lack of supplies in our unit, we chose ceftriaxone, which is used in patients with penicillin allergies. The use of this drug has shown good outcomes in different reviews.

Due to the use of appropriate treatment, the patient is currently stable and has no recurrence of skin lesions. Malignant syphilis should be considered as part of the differential diagnosis in patients who present with nodulo-ulcerative lesions and have a positive treponemal or non-treponemal test.