RARE PRESENTATION OF UMBILICAL CONDYLOMA

Objectives: BACKGROUND

Syphilis is a systemic infection caused by the spirochete Treponema pallidum and is acquired primarily through sexual contact, although transmission may occur via skin-skin contact, blood transfer, or congenital infection. Syphilis progresses through three clinically distinct stages depending on the elapsed time from exposure. These stages are known as primary, secondary, and tertiary infection. Condyloma lata, the cutaneous manifestation associated with secondary syphilis, are described as well-demarcated, hypertrophic papules or plaques that are highly infectious due to a large concentration of spirochetes within. These lesions are mainly found around the genitals or anus; however, they may also be found infrequently in areas such as the umbilicus, nasolabial folds, axilla, palate, ankle, and neck.

CASE PRESENTATION

The patient is a 60-year-old male found to be human immunodeficiency virus (HIV) positive who presented to clinic in August 2022 for evaluation of anal, umbilical, and penile condyloma lata. The patient first noticed lesions developing on his penile shaft and thigh in 2017 and reports that they began to gradually increase in size. The patient underwent two excision and fulguration procedures in 2017, each of which associated with surgical pathology that was negative for high-grade dysplasia. In 2021, the patient noticed the lesions began to develop within his umbilicus. At the time of his clinic visit in 2022, the umbilical condyloma measured 5cm in size, as seen in Image 1. The patient is currently awaiting excision and fulguration procedure.

DISCUSSION

This report describes a rare case of condyloma lata discovered in the umbilicus, as well as others found in his anal and penile regions. Among patients who desire treatment, excision and fulguration is an option for definitive management. Performing biopsies of the lesions during the procedure can assist in determining the degree of dysplasia present, if any, and allows for other etiologies of condylomatous lesions, such as condyloma acuminata, to be evaluated as well. This is essential for appropriate treatment and surveillance of lesions, and should also prompt testing for other STI’s, including syphilis.

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