[The role of reflectance confocal microscopy in the diagnosis of secondary syphilis of the vulva and anus: A first case report]

Abstract

Patients and methods: Herein we report the case of an 18-year-old pregnant patient presenting with plantar and ano-genital lesions of syphilis, pharyngitis, erythematosus and scalynasolabial intertrigo and angular cheilitis.

Reflectance confocal microscopy: In vivo reflectance confocal microscopy examination (Vivascope 3000^®; Caliber Inc, Rochester, NY, USA, distributed in France by Mavig, Munich) of ano-genital lesions enabled us to identify hyper-reflective elongated rods in the papillary dermis suggesting spirochetes. The diagnosis was confirmed by TPHA and VDRL as well as immunohistological examination.

Comments: We identified for the first time rod shaped structures in ano-genital lesions of secondary syphilis, regularly alternating hyper-reflective and non-reflective areas corresponding to helix-shaped treponemes visualized by darkfield microscopy, which may not be confused with other cell structures.

Keywords: Imagerie non invasive; In vivo; Microscopie confocale par réflectance; Non-invasive imaging; Reflectance confocal microscopy; Syphilis; Treponema pallidum.