Stevens-Johnson syndrome as the presenting manifestation of human immunodeficiency virus and syphilis coinfection

Stevens-Johnson syndrome (SJS) is a severe cutaneous adverse reaction frequently associated with a drug and, rarely, with an infection. It is characterized by atypical targetoid lesions resulting in epidermal detachment of the skin and mucosa. We report a SJS case as the initial manifestation in human immunodeficiency virus (HIV) and syphilis coinfection and explore the potential pathomechanism leading to its development. A 25-year-old man presented to the emergency room with a 1-week history of erythematous to violaceous macules and patches. This was accompanied by fever, cough, and colds. The lesions evolved into blisters with areas of erosion. He was admitted and diagnosed with SJS based on clinical and histopathologic findings. However, no potential drug triggers were identified. Further laboratory studies found and confirmed HIV and syphilis coinfection. The study explored the potential role of HIV and syphilis coinfection in the development of SJS. Immune dysregulation and concomitant infection in the skin of an HIV patient were considered as factors in the development of SJS in this case. A comprehensive review for potential infection must be warranted among patients with SJS, especially in those cases without a clear culprit drug trigger. Further reports must be documented to establish the occurrence of SJS in newly diagnosed HIV.