A CAPITE AD CALCEM APPROACH IMPORTANCE IN CASE OF SYPHILIS

Abstract

Background Nowadays, the patient full examination is challenging by limited time in different medical fields (Musellim B. et al, 2017). It can lead inappropriate diagnosis and treatment. Therefore, it is important to use patient examination gold Approach a capite ad calcem. Methods The medical documentation, pathology slides and data of laboratory results were reviewed in the context of upto-date medical literature. Results A 34-year-old white man presents with a complaint about itching on his legs and arms that follow him around four months. In objective examination of the overall status – without any deviation of the norm. In the local status, we found infiltrative, hyperaemic papules with yellowish crusted erosions on both legs and arms with well demarcated. On both legs we found varicose veins. Sexual history said that last sexual contact had been two years ago. The full blood test, infection tests (HIV, RPR, TPHA, HCV), microbiology and skin punch biopsy were done. Work diagnosis at the beginning: exacerbation of chronic eczema. Important to keep in mind, cutaneous features of secondary syphilis sometime can show as chronic dermatitis. The blood test result, total IgE showed without any deviation of the norm. RPR – positive (4+), TPHA (4+, 1:1280), HIV – negative, HCV – negative. Excreted from the skin: Staphylococcus aureus, Streptococcus pyogenes (beta haemolytic group A). Other sexual transmissive disease – negative. The skin punch biopsy was done from arm skin. At the pathophysiological conclusion said that: histological picture is possible in the case of Lyme disease. Lyme disease parameters are not determined due to treatment interruption at the patient‘s request. Conclusion A capite ad calcem approach is an essential part in dermatovenerology practice. It can help for doctor find not just seemingly the main reason for patient‘s complain but allow watch wider.