PROZONE PHENOMENON IN HIV NEGATIVE PATIENT

  • Priscila Tortelli Bitencourt Estagiária em Dermatologia/Resident of Dermatology,Policlínica Geral do Rio de Janeiro – PGRJ, Brasil
  • Priscila Coelho Mariano Estagiária em Dermatologia/Resident of Dermatology,Policlínica Geral do Rio de Janeiro – PGRJ, Brasil
  • Carlos Gustavo Carneiro de Castro Especialista em Dermatologia pela Sociedade Brasileira de Dermatologia/Specialist in Dermatology, Clínica Privada/ Private Clinic, Rio de Janeiro, Brasil
  • Karoline Silva Paolini Medica Graduada/Medical Graduated, Universidade Iguaçu, Rio de Janeiro, Brasil
  • Carolina Degen Meotti Especialista em Dermatologia pela Sociedade Brasileira de Dermatologia/ Specialist in Dermatology, Clínica Privada/ Private Clinic, Rio de Janeiro, Brasil
  • Ludmila de Matos Reis Franco Medica Graduada/Medical Graduated, Universidade Federal de Juiz de Fora, Rio de Janeiro, Brasil
Keywords: False negative reactions, Female, Syphilis serodiagnosis, Syphilis

Abstract

Prozone phenomenon results from high antibody titers in patients with syphilis, causing a false negative Venereal Disease Research Laboratory (VDRL) results. We report a case of a 50-year-old female patient, with a chief complaint of diffuse, erythematous and asymptomatic lesions, conjunctival hyperemia in her left eye. The physical examination: maculopapular rash on the trunk, back, abdomen and face and right epitrochlear adenopathy. She brought general tests within normal limits and negative VDRL. We requested FTA-ABS IgG:+ and VDRL in diluted serum: 1:512. The optimal ratio of the antigen/antibody yields an insoluble precipitate that is visible, thus rendering the test positive. Thus, phenomenon prozon was confirmed.

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References

Sidana R, Mangala HC, Murugesh SB, Ravindra K. Prozone phenomenon in secondary syphilis. Indian J Sex Transm Dis 2011; 32:47-9.

Singh AE, Romanowski B. Syphilis: review with emphasis on clinical, epidemiologic and some biologic features. Clin Microbiol Rev. 1999; 12:187-209.

Codes JS, Cohen DA, Melo NA, Teixeira GG, Leal Ados S, Silva Tde J, et al. Screening of sexually transmitted

diseases in clinical and non-clinical settings in Salvador, Bahia, Brazil. Cad Saude Publica. 2006; 22:325-34.

Azevedo LKA; Fernandes PSG; Silva DGKC; Neto MJB; Queiroz MGL; Dantas VCR et al. Caracterização e correlação do fenômeno pró-zona com títulos de sororeatividade do VDRL e reação de imunofluorescência indireta em soros de pacientes com sífilis RBAC. 2006; 38(3): 183-7.

Azulay RD, Azulay DR. Dermatologia. 5ed. Rio de Janeiro: Guanabara Koogan; 2008.

Wuepper KD, Tuffanelli DL. False positive reaction to VDRL test with prozone phenomena.Association of lymphosarcoma. JAMA. 1966; 195:868-9.

Avelleira JC, Bottino G. Sífilis: diagnóstico, tratamento e controle. An Bras Dermatol. 2006; 81(2) :111-26.

Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin Microbiol Rev. 1995; 8:1-21.

Rompalo AM, Cannon RO, Quinn TC, Hook EW. Association of biologic false-positive reactions for syphilis with human immunodeficiency virus infection. J Infect Dis. 1992; 165:1124-6.

Musher DM, Hamill RJ, Baughn RE. Effect of human immunodeficiency virus (HIV) infection on the course of syphilis and on the response to treatment. Ann Intern Med. 1990; 113:872-81.

Johnson PD, Graves SR, Stewart L, Warren R, Dwyer B, Lucas CR. Specific syphilis serological test may become negative in HIV infection. AIDS. 1991; 5:419-23.

Nayak S, Acharjya B. VDRL Test and its Interpretation. Indian J Dermatol. 2012; 57(1):3-8.

Brasil. Ministério da Saúde. Manual de Controle das Doenças Sexualmente Transmissíveis. 3ed. Brasília: Ministério da Saúde; 1999.

Erbelding EJ, Vlahov D, Nelson KE, Rompalo AM, Cohn S, Sanchez P, et al. Syphilis serology in human immunodeficiency virus infection: Evidence for false-negative fluorescent treponemal testing. J Infect Dis. 1997; 176:1397-400.

Augenbraun MH, DeHovitz JA, Feldman J, Clarke L, Landesman S, Minkoff HM. Biological false-positive

syphilis test results for women infected with human immunodeficiency virus. Clin Infect Dis. 1994; 19:1040-4.

Sampaio SAP; Rivitti EA. Dermatologia. 3ª ed. São Paulo: Artes Médicas; 2007.

Lane HC, Masur H, Edgar LC, Whalen G, Rook AH, Fauci AS. Abnormalities of cell activation and immunoregulation in patients with the acquired immunodeficiency syndrome. N Engl J Med. 1983; 309:453-8.

Malone JL, Wallace MR, Hendrick BB, LaRocco A, Jr, Tonon E, Brodine SK, et al. Syphilis and neurosyphilis

in a human immunodeficiency virus type-1 seropositive population: Evidence for frequent serologic relapse after therapy. Am J Med. 1995; 99:55-63.

Published
2014-09-19
How to Cite
Bitencourt, P. T., Mariano, P. C., de Castro, C. G. C., Paolini, K. S., Meotti, C. D., & Franco, L. de M. R. (2014). PROZONE PHENOMENON IN HIV NEGATIVE PATIENT. Journal of the Portuguese Society of Dermatology and Venereology, 72(2), 259-262. https://doi.org/10.29021/spdv.72.2.266
Section
Case Reports