Академический Документы
Профессиональный Документы
Культура Документы
Background: Condylomata lata of the toe webs are uncommon manifestations of secondary syphilis. Considering the
recent decline in the incidence of syphilis in the United States,
such lesions are likely to present infrequently. In some cases,
this phenomenon may be the only physical sign of syphilis;
therefore, it is important that a high index of suspicion is
maintained when evaluating toe web lesions in patients at
epidemiologic risk for syphilis.
Goals: A case of secondary syphilis presenting solely with
interdigital condyloma lata in the toe web spaces is reported,
and similar cases reported in the literature are reviewed.
Study Design: This article documents the diagnosis of secondary syphilis based on a positive serology in conjunction
with the development of interdigital condyloma lata as the only
physical finding suggestive of lues.
Results: The latter lesions resolved after appropriate, adequate antibiotic therapy.
Conclusions: A case of condylomata lata of the toe webs
without other pertinent physical findings is presented. Analogous to lesions typically seen in the anogenital region, moist
exophytic toe web plaques may represent condyloma lata and
thereby be a sign of secondary syphilis. The differential diagnosis includes tinea pedis, erythrasma, macerated corns, verrucae, and several tropical mycoses (chromomycosis,
mycetoma).
lis. Condylomata lata of the toe webs are uncommon manifestations of secondary syphilis that have been highlighted
infrequently in recent medical publications. In the last 60
years, there have been only five published reports in the
English language that describe condylomata lata of the toe
webs in a total of 20 patients.2 6 In an effort to increase
awareness of this unusual finding, a case of interdigital
condylomata lata is presented and various other parameters
pertaining to these lesions are analyzed. Previously reported
cases are also reviewed.
Case Report
During routine blood screening, a 42-year-old black man
was found to have a positive rapid plasma reagin result in a
titer of 1:128. The patient was subsequently referred to a
dermatology service for evaluation. The patient admitted to
multiple episodes of unprotected sexual intercourse with
anonymous partners within the preceding 6 months and
gave a vague history of a transient, painless penile lesion of
approximately 2 months duration, but was otherwise
asymptomatic. Physical examination disclosed oozing
papulonodular lesions located in interdigital web spaces
between the third and fourth and the fourth and fifth toes on
one foot, and in the webspace between the third and fourth
toes on the other foot (Fig. 1). Results of darkfield examination of the serous exudate obtained from one of these
lesions were positive, confirming the diagnosis of secondary syphilis. The remainder of the physical examination was unremarkable, and screening HIV serology was
negative. One month after treatment with intramuscular
benzathine penicillin 2.4 million U, the pedal lesions had
entirely resolved, and the rapid plasma reagin titer had
decreased to 1:4.
184
185
Vol. 28 No. 3
Discussion
Fig. 1. Darkfield-positive moist plaques (condylomata lata) between the third and fourth toes of the right foot.
TABLE 1.
Demographic Data*
20-year-old
34-year-old
26-year-old
28-year-old
39-year-old
22-year-old
24-year-old
28-year-old
19-year-old
23-year-old
23-year-old
22-year-old
16-year-old
25-year-old
28-year-old
47-year-old
47-year-old
BM
WM
WM
WM
BM
BW
BW
BM
BW
WW
WW
BW
BG
BM
BM
BM
BM
Number of Toe
Web Lesions
Reference
Number
1
2
2
2
1
1
2
2
1
2
1
1
1
1
2
1
2
2
2
2
3
3
3
3
3
3
3
3
3
3
4
5
6
6
*No demographic data for three of six patients reported in Arch Dermatol Syphilol, 1940.
BM black man; WM white man; BW black woman; WW white woman; BG black girl.
186
March 2001
References
1. Centers for Disease Control and Prevention. Primary and secondary
syphilisUnited States, 1998. MMWR Morb Mortal Wkly Rep 1999;
48:873 878.
2. Thomas EW, Bluefarb SM. Early syphilitic lesions mistaken for dermatophytosis. Arch Dermatol Syphilol 1940; 42:1114.
3. Dexter HT. Interdigital infectious syphilitic lesions simulating dermatophytosis. Arch Dermatol 1951; 63:581585.
4. Minkin W, Landy SF, Cohen HJ. An unusual solitary lesion of secondary syphilis. Arch Dermatol 1967; 95:217.
5. Hira SK. Condylomata lata of the toewebs: a case report of an unusual
manifestation of syphilis. Sex Transm Dis 1984; 11:167168.
6. Templeton SF. Condyloma latum of the toe webs: an unusual manifestation
of secondary syphilis. A report of two cases. Cutis 1996; 57:38 40.