International Journal of Clinical Case Reports and Reviews Copy rights@ Satiti Retno Pudjiati et.al. Auctores Publishing – Volume 6(5)-0111 www.auctoresonline.org ISSN: 2690-4861 Page 1 of 3 Moth-Eaten Essential Syphilitic Alopecia in Human Immunodeficiency Virus-Positive Patient: A Case Report Satiti Retno Pudjiati * , Beatrix Novandri Uly, Carolina Kurniawati, Devi Artami Susetiati, Agnes Sri Siswati Dermatology and Venereology Department, Faculty of Medicine, Nursing and Public Health Universitas Gadjah Mada / RSUP Dr. Sardjito Yogyakarta, Indonesia *Corresponding Author: Satiti Retno Pudjiati, Dermatology and Venereology Department, Faculty of Medicine, Nursing and Public Health Universitas Gadjah Mada / RSUP Dr. Sardjito Yogyakarta, Indonesia. Received date: January 29, 2021; Accepted date: April 02, 2021; Published date: April 05, 2021 Citation: Satiti R Pudjiati, Beatrix N Uly, C Kurniawati, Devi A Susetiati, Agnes S Siswati. (2021) Moth-Eaten Essential Syphilitic Alopecia in Human Immunodeficiency Virus-Positive Patient: A Case Report. International Journal of Clinical Case Reports and Reviews. 6(5); DOI:10.31579/2690-4861/111 Copyright: © 2021 Satiti Retno Pudjiati, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Hair loss is rare to be reported as sole manifestation of secondary syphilis. Syphilitic alopecia consists of symptomatic syphilitic alopecia that presents with other secondary syphilis manifestation, and essential syphilitic alopecia which can be patchy ("moth-eaten" type), diffuse, or combination without other manifestations of secondary syphilis. Here we report a case of secondary syphilis in patient with Human Immunodeficiency Virus (HIV) that present with moth-eaten alopecia as a sole manifestation. A 35-year-old male with HIV complained hair loss on his scalp and eyebrows. Physical examination showed non scarring moth-eaten alopecia on his scalp and lossof lateral third of his eyebrows without other lesions. Serological test for syphilis was positive. He was treated with 2.4 millions unit of benzathine penicillin G (BPG), single dose intramuscular injection. Six months after injection, patient showed clinical and serological improvement. Syphilitic alopecia cannot be ruled out in patients with non scarring hair loss with unclear etiology. Serological tests are recommended especially for patients with history of high risk sexual behaviour. Keywords: moth-eaten alopecia; secondary syphilis; HIV Introduction Syphilitic alopecia (SA) is a rare cutaneous manifestation of secondary syphilis, ranging from 2.9 to 7% of all cases. Its presentation varies from diffuse to moth-eaten pattern, or combination of both. The scalp is the most commonly affected area. However, eyebrows, eyelashes, hair in axilla, pubic area, chest, and legs can also be affected. Of these, moth- eaten SA is the most commonly found and it presents as patchy alopecia in varying size, indistinct borders resembling the hair was eaten by moth. It mainly occurs in the parieto-occipital area [3, 4]. In 1940, Mc Carthy divided SA into 2 types including symptomatic syphilitic alopecia and essential SA with alopecia as the only presenting symptom [1, 2] Moth- eaten alopecia accounted for 2.9 to 48% of all reported cases of secondary syphilis and very rarely reported as a sole manifestation of secondary syphilis. Delay in diagnosis can increase the risk of syphilis progression to tertiary stage and resulting mortality [5, 6]. Case Presentation A 35-year-old male, came to the dermatology and venereology outpatient department in Dr. Sardjito Hospital with chief complaint of hairloss on the scalp and eyebrows. Three months prior to consultation, he complained of some small areas of hair loss on his scalp, which then increased in number and size. He also noted to have thinning of his lateral eyebrow. There were no itch and pain sensation. Patient did not seek consult and no medication was applied nor taken. Patient admitted history of painless ulcer on his genital area prior to the hairloss but he did not seek consultation for the ulcer and it was spontaneously healed. Patient denied history of trauma prior to the ulcer and hairloss. Patient is bisexual and has 1 female partner and multiple male partners. Patient is known to have HIV and has started treatment using nevirapine, lamivudine and zidovudine. Upon examination, the Cluster of Diffrentiation (CD) 4+ was 301 cells / mm3. Venereal Disease Research Laboratory (VDRL) titer was 1:32 and Treponema Pallidum Hemagglutation Assay (TPHA) was positive. On that point, patient appeared well, vital signs were within normal limits and no palpable lymph nodes. There were multiple patches of hairloss measuring 0.5 to 1 cm in size over the temporal, parietal and occipital regions (Figure 1A). No sign of inflammation was noted. The hair pull test was negative. Alopecia patches were also noted on the lateral third of both eyebrows (Figure 2A). No active lesions over other body parts. The patient was diagnosed as a case of moth-eaten essential syphilitic alopecia. He was given a single dose of BPG 2.4 million units intramuscularly. Two months after treatment, the hair was almost fully regrowth (Figure 1B&2B) and on the six months follow up, VDRL titer has decreased to 1: 2. Open Access Research Article . International Journal of Clinical Case Reports and Reviews Satiti Retno Pudjiati* AUCTORES Globalize your Research