体重減少を主訴にした第2期梅毒

・患者は高齢者で食欲低下，体重減少といった全身症状が受診起点となっており，診断に苦慮した．

・皮疹の鑑別としてはリンパ腫を第一に考えたが，病理組織学的に否定された．

・3 mm大の均一な紅斑であり定型的な梅毒性バラ疹にしては小さく，初診時で梅毒2期疹と診断できなかった．

・ステロイド外用で改善せず，皮疹が遷延化したため梅毒2期疹も鑑別にあげ，血清検査を追加し，第2期梅毒と診断しえた．

（「症例のポイント」より）

　

A case of secondary syphilis with weight loss

　

Hasegawa, Takumi1）Yatsushiro, Hiroshi2）Hasegawa, Yoshinori2） 1）Department of Dermatology, University of Fukui Hospital 2）Department of Dermatology, Fukui Prefectural Saiseikai Hospital

　

A 73-year-old man visited his physician with chief complaints of anorexia and weight loss. Because small erythemas were observed on his trunk, he was referred to our department. His past and medication histories were unremarkable. His soluble interleukin-2 receptor level was high, and erythrocyte sedimentation rate was elevated. Because topical steroid therapy failed to relieve the skin rash, a skin biopsy was performed, which indicated that lymphoma was unlikely. A serologic test for syphilis yielded a positive result, which led to the diagnosis of secondary syphilis. Oral amoxicillin therapy was initiated, and nearly complete remission was achieved 2 months later. In recent years, reports of elderly patients with syphilis have been increasing. Furthermore, because secondary syphilis may manifest as various types of skin rashes and symptoms, attention is required not to miss the diagnosis of syphilis.