Syphilitic lymphadenopathy - Histology and human immunodeficiency virus status

Few reports on syphilitic lymphadenopathy have appeared in 20 years, and no ne have compared findings in patients with and without human immunodeficien cy virus (HIV) infection, despite the recent epidemic spread of syphilis an d HIV. Twelve cases of syphilitic lymphadenopathy were studied and grouped according to HIV status. Patients were 21 to 62 years old (median, 29 years ); 7 were men, 5 were women. Biopsy sites were cervical (7 cases), inguinal (4), and axillary (1) lymph nodes. All patients had evidence of syphilis. Rapid plasma reagin titers ranged from 1:32 to 1:512. Treponemal hemaggluti nation was positive in all cases tested. Spirochetes were found with Steine r staining in 2 cases. HIV testing was positive in 4, negative in 2, and un known in 6 cases. Lymph nodes were enlarged and often fragmented due to cap sular fibrosis and chronic inflammation, with focal obliteration of the sub capsular sinus. Follicular and interfollicular hyperplasia was seen in all cases and was usually marked, with prominent vascular proliferation, plasma cells, immuno-blasts, histiocytes, and occasional neutrophils. Follicle ls is and granulomas suggestive of unconfirmed toxoplasmosis were each seen in 1 case, and Kaposi sarcoma in 2, all in HIV-positive patients. Lymphoplasm acytic infiltration was marked, especially in interfollicular areas, with p eri-vascular plasma cell cuffing in all cases and obliterative endarteritis in about half (7 of 12,56%). Immunostaining for CD45RO (UCHL-1), CD20 (L26 ), kappa, lambda, and CD68 (Kp-1) revealed a mixed population of T cells, p olyclonal B cells, and interfollicular histiocytes. Distribution of T and B cells (immunoarchitecture) was essentially normal and similar in all cases , regardless of HIV status. Syphilis produces essentially identical finding s in lymph nodes in both HIV-positive and HIV-negative patients. The morpho logic findings described should prompt evaluation for infection wit Trepone ma pallidum and, in light of the current epidemic, HIV.