Syphilitic peripheral vascular disease: a case report
Pavithran, K.
Indian Journal of Sexually Transmitted Diseases 10(2): 79-81
1989
ISSN/ISBN: 0253-7184 PMID: 12284237 Document Number: 375687
This report examines the case of a 32 year-old man suffering from gangrene of the toes, a condition whose cause appeared to be syphilis. The man had initially developed a painful ulcer with blackish discoloration on the little toe. In 3 weeks time, the ulcer had spread to the 4th toe. The man had no history of local trauma, of ingestion of drugs, of tobacco smoking, and no one in his family suffered from diabetes of hypertension. 8 years back, however, the individual had developed an ulcer at the glans penis following sexual intercourse with a prostitute. The ulcer disappeared within 4 weeks. An examination revealed that the toes were gangrenous. While routine laboratory tests on blood, urine, and stool were normal, angiography revealed partial obstruction to the flow of dye at the levels of external iliac, femoral and popliteal arteries on the left side. Treatment with vasodilators did not succeed, and the gangrene continued to spread. He was then treated with benzathine penicillin. After 8 days of treatment, a "line of demarcation" developed between the dead and living tissues at the base of the gangrenous toes. At that point, the 2 toes were amputated. The gangrene did not progress any farther, and he had complete relief of symptoms. 2 years after there had been no recurrence of gangrene or of the peripheral vascular occlusive disease. While the exact pathological nature of these obstructive vascular lesions is not known, a reactive blood VDRL test and the therapeutic response to penicillin in the form of improvement in blood flow and the prevention of the spread of gangrene suggests that the vascular disease was due to syphilis.