Gede Yoga Utama Putra
Mangusada Regional General Hospital

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The Great Imitator Meets Pruritic Papular Eruption: A Case of Secondary Syphilis and HIV Co-Infection Gede Yoga Utama Putra; Anak Agung Ari Agung Kayika Silayukti; Tjokorda Istri Amrita Rosvanti; Anak Agung Istri Saraswati Dewi; Made Hemina Laksmi
Indonesian Journal of Global Health Research Vol. 8 No. 5 (2026): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v8i5.2379

Abstract

Secondary syphilis, notoriously known as "the great imitator," can present with highly atypical cutaneous manifestations, particularly in immunocompromised individuals. In patients with human immunodeficiency virus (HIV) co-infection, distinguishing secondary syphilis from HIV-associated dermatoses, such as pruritic papular eruption (PPE), poses a significant diagnostic challenge. This report aims to describe an atypical case of secondary syphilis mimicking PPE in a newly diagnosed HIV patient, to highlight the diagnostic complexities and the potential risks of inappropriate empiric systemic corticosteroid therapy. A 26-year-old male presented with a one-month history of a generalized, intensely pruritic, and crusted papular rash. His condition rapidly disseminated and worsened following empiric treatment with systemic corticosteroids by a general practitioner. Dermatological examination revealed generalized, well-demarcated erythematous papules with overlying crusts and fine scales, closely mimicking PPE. The patient reported a history of high-risk sexual behavior. Serological testing confirmed active secondary syphilis (VDRL 1:64, TPHA reactive) and revealed a previously undiagnosed HIV infection. The patient was successfully treated with a single dose of intramuscular benzathine penicillin G (2.4 million IU) and topical therapy comprising desoximetasone 0.25% and gentamicin 0.1% creams, alongside an immediate referral for antiretroviral therapy (ART). This case highlights the clinical overlap between atypical secondary syphilis and PPE in HIV-positive patients. It strongly underscores the critical need for comprehensive sexually transmitted infection (STI) screening prior to initiating systemic immunosuppressive therapy for generalized eruptions, especially in high-risk populations. 
Efficacy and Safety of Anifrolumab in Patients with Cutaneous Lupus Erythematosus: A Systematic Review Gede Yoga Utama Putra; Anak Agung Ari Agung Kayika Silayukti; Tjokorda Istri Amrita Rosvanti; Anak Agung Istri Saraswati Dewi; Made Hemina Laksmi
Indonesian Journal of Global Health Research Vol. 8 No. 5 (2026): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v8i5.2515

Abstract

Cutaneous lupus erythematosus (CLE) significantly impacts patient quality of life, and many cases remain refractory to standard-of-care treatments such as antimalarials and corticosteroids. Anifrolumab, a type I interferon receptor antagonist, has shown efficacy in systemic lupus erythematosus (SLE), but its specific impact on diverse CLE subtypes in real-world settings requires further synthesis. To systematically review the clinical efficacy, safety, and steroid-sparing potential of anifrolumab in patients with CLE. A systematic literature search was conducted across PubMed, ScienceDirect, and Cochrane Library for articles published between 2021 and 2026. From an initial yield of 217 articles, 5 studies reporting on anifrolumab treatment for CLE subtypes were ultimately included after rigorous screening. Data on clinical response, specifically the cutaneous lupus erythematosus disease area and severity index (CLASI) scores and onset of action, were extracted and synthesized. Five studies involving a total of 40 patients were included. The majority of patients had failed multiple prior therapies. Results consistently showed a rapid and significant decrease in CLASI activity scores, often within the first 4 to 12 weeks of aniflorumab treatment. Notably, one major cohort reported that 50% of patients were able to discontinue prednisone entirely. Efficacy was observed across various subtypes, including discoid lupus erythematosus (DLE) and subacute CLE (SCLE) cases. Adverse events were consistent with previously reported safety profiles. Real-world evidence suggests that anifrolumab is a potent and rapid-acting treatment for refractory CLE, offering significant clinical improvement and a vital steroid-sparing effect. These findings support its use in patients failing conventional therapies, though large-scale prospective trials specifically for CLE are warranted.