Background:Malignant syphilis is considered a rare disease, more commonly affecting individuals with poor immunity. We report a case of acquired immune deficiency syndrome with Repeated crusted ulcerations. Our report shows the typical skin lesions of malignant syphilis and a reinfection with the same rashes.
Case presentation:A 22-year-old homosexual male was admitted to hospital for fever and ulcerations with overlying brown–black rupioid crusts. Then he was confirmed human immunodeficiency virus infection. Malignant syphilis was diagnosed by positive markers and biopsy pathology. After application of benzathine penicillin for 3 weeks, the symptoms improved and rapid plasma regain (RPR) decreased from 1:64 to 1:4 in 8 months. But the patient appeared with rashes that was accurately the same with rashes before 13 months later，and RPR rose to 1:128, that was likely to be re-infection after frequent sexual activity. And he responded well to doxycycline treatment.
Conclusion: Malignant syphilis is a rare form of secondary syphilis, but tends to occur in acquired immune deficiency syndrome patients because of poor immunity. Although the clinical manifestations of malignant syphilis are severe, the response to the therapy of penicillin and doxycycline are excellent, even with repeated infection.