The remaining skin as well as oral and genital mucous membranes showed no abnormalities the lymph nodes were not enlarged, and no alopecia or any other signs of secondary syphilis could be detected. Furthermore, several discrete erythematosquamous lesions on the palms and soles ( Figure 3), each about 1 cm in diameter, were found the patient had not been aware of them. Both our patient and her spouse denied having had any extramarital relations in the recent past.Ĭlinical inspection of the patient disclosed a solitary erythematous, hyperkeratotic annular plaque of 2.5 cm in diameter in the left thoracolumbar area, resembling tinea corporis, a psoriatic plaque, granuloma annulare, or hyperkeratotic lichen planus ( Figure 1 and Figure 2). On questioning, she told us that her husband had observed a similar lesion in his right subaxillary region about 4 months before but that it had disappeared spontaneously a routine test of her husband's serum before minor surgery in Cuba had disclosed a positive serological test result for syphilis, and the husband had then been treated with penicillin. She did not remember any fever, tick bites, changes in oral or genital mucous membranes, joint pain, or lymphadenopathy. This lesion had lasted for almost 1 month when she was examined at our outpatient clinic. Direct skin-to-skin contact is the likely mechanism of transmission.Ī 28-year-old white Austrian woman, who was married to a native Cuban and had lived for the past 7 years in an urban area of Cuba, developed a solitary erythematosquamous plaque on the left side of her trunk. The main reservoir of pinta is young adults, who have chronic skin lesions. Histopathological investigations show moderate acanthosis, spongiosis, sometimes hyperkeratosis and hypergranulosis, and liquefaction generation of the basal layer in the epidermis, and a perivascular dermal infiltrate composed of lymphocytes, plasma cells, and neutrophils in the upper dermis. These lesions are not believed to be infectious. In the late stage of pinta III (months to 10 years after the appearance of pintids), lesions marked by vitiligolike depigmentation are the leading feature. These highly infectious secondary lesions may be sparse or numerous and, after healing, leave areas of gray, brown, or slate blue hyperpigmentation or depigmentation. Several months to years after appearance of the initial lesion, small scaly papules that enlarge to psoriasiform plaques, "pintids," may develop. The primary lesion appears as a small papule or erythematous macule 7 to 70 days after inoculation and extends within several weeks to an erythematous infiltrated plaque of up to 12.5 cm in diameter. Like venereal syphilis, pinta chronically relapses. 1 The lesions of pinta are characterized by first hyperkeratotic and later dyschromic eruptions. Pinta, which is endemic only in the western hemisphere, is the most benign spirochetal disease, showing only skin manifestations and occasionally mild systemic symptoms ( Table 1). However, they differ significantly from syphilis in their mode of transmission, epidemiology, and clinical manifestation. THE NONVENEREAL treponematoses yaws, endemic syphilis (bejel), and pinta are caused by an organism that is morphologically and antigenically identical to the causative agent of venereal syphilis, Treponema pallidum. Positive serological findings for active syphilis and the detection of spirochetes in the trunk lesion indicated early secondary syphilis, but an extensive case history and the clinical appearance fulfilled all criteria for pinta.Ĭonclusion The acquisition of a distinct clinical entity, pinta, in a country where it was formerly endemic but now is believed to be extinct raises the question of whether the disease is in fact extinct or whether syphilis and pinta are so similar that no definite distinction is possible in certain cases. Observation A native Austrian woman, who had lived for 7 years in Cuba and was married to a Cuban native, developed a singular psoriasiform plaque on her trunk and several brownish papulosquamous lesions on her palms and soles during a visit to her home in Austria. Only scattered foci may still remain in remote areas in the Brazilian rain forest, and the last case from Cuba was reported in 1975. Shared Decision Making and Communicationīackground Pinta, 1 of the 3 nonvenereal treponematoses, is supposed to be extinct in most areas in South and Central America, where it was once endemic.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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