Eosinophil rich infiltrate in secondary syphilis a rare histopathological variant
Keywords:Secondary syphilis, Eosinophils, Histopathology
Secondary syphilis is a sexually transmitted infection, which is referred to as “the great imitator” and has a wide spectrum of clinical manifestations. Syphilis is classically associated with plasma cells and the presence of eosinophils usually argues against a diagnosis of syphilis. The differential diagnosis for eosinophil-rich skin lesions often includes a drug reaction, arthropod-bite reaction, allergic contact dermatitis, and a response to a helminth infestation. However, many unrelated entities, such as infections, neoplasms, and inflammatory dermatoses can have prominent eosinophilic infiltrate. We report a case of secondary syphilis which on histopathology showing psoriasiform hyperplasia with superficial perivascular infiltrate and on higher magnification these infiltrate were predominantly lymphohistiocytic along with the moderate amount of eosinophils with a paucity of plasma cells. This case report is presented to highlight the need for including secondary syphilis as one of the differential diagnoses in the presence of eosinophil-rich infiltrate when it is suspected clinically.
World Health Organization. Prevalence and incidence of selected sexually transmitted infections: Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis and Trichomonas vaginalis: Methods an results used by WHO to generate 2005 estimates. WHO. 2011:1-38.
Jeerapaet P, Ackerman AB. Histologic Patterns of Secondary Syphilis. Arch Dermatol. 1973;107(3):373-7.
Liu XK, Li J. Histologic Features of Secondary Syphilis. Dermatology. 2020;236(2):145-50.
Rosa G, Bennett D, Piliang MP. Eosinophil-rich syphilis: A report of four cases. J Cutan Pathol. 2015;42(8):554-8.
Flamm A, Parikh K, Xie Q, Kwon EJ, Elston DM. Histologic features of secondary syphilis: A multicenter retrospective review. J Am Acad Dermatol. 2015;73(6):1025-30.
Magalhaes ES, Paiva CN, Souza HSP. Macrophage migration inhibitory factor is critical to interleukin‐5‐driven eosinophilopoiesis and tissue eosinophilia triggered by Schistosoma mansoni infection . FASEB J. 2009;23(4):1262-71.
Nagata Y, Yoshihisa Y, Matsunaga K, Rehman MU, Kitaichi N, Shimizu T. Role of macrophage migration inhibitory factor (MIF) in pollen-induced allergic conjunctivitis and pollen dermatitis in mice. PLoS One. 2015;10(2):1-13.
Davis MDP, Perniciaro C, Dahl PR, Randle HW, McEvoy MT, Leiferman KM. Exaggerated arthropod-bite lesions in patients with chronic lymphocytic leukemia: A clinical, histopathologic, and immunopathologic study of eight patients. J Am Acad Dermatol. 1998;39(1):27-35.
Podwinska J, Lusiak M, Zaba R, Bowszyc J. The pattern and level of cytokines secreted by Th1 and Th2 lymphocytes of syphilitic patients correlate to the progression of the disease. FEMS Immunol Med Microbiol. 2000;28(1):1-14.
Takatsu K, Nakajima H. IL-5 and eosinophilia. 2008;5:288-94.
Park JH, Kim YC. Secondary syphilis with numerous eosinophils. J Cutan Pathol. 2013;40(12):1063-4.
Sharon VR, Konia TH, Barr KL, Fung MA. Assessment of the “no eosinophils” rule: Are eosinophils truly absent in pityriasis lichenoides, connective tissue disease, and graft-vs.-host disease? J Cutan Pathol. 2012;39(4):413-8.