Infections characterized by a lymphocytic immunologic response

T cell-mediated immunity is critical in orchestrating and effecting the immune response, and the presence of T cells in skin can be demonstrated in almost all dermatological infections. Although humoral responses may play a pivotal role in the dermatological manifestations of many infectious processes (measles, for example), a dermatological response characterized by the presence of antibody-producing B cells or plasma cells in skin is rare. Dermal involvement during primary syphilis, however, is one such example. A primary syphilitic chancre develops at the site of skin penetration by the spirochete Treponema pallidum. The chancre is usually 1-2 cm in size with regular, raised, indurated, sharply defined borders. The lesion is classically painless and resolves within 1-2 weeks with treatment, or 3-6 weeks without therapy. Late manifestations of secondary or tertiary syphilis can occur if the infection is not appropriately treated. Histopathological examination of a primary syphilitic chancre discloses lymphocytic infiltration of the epidermis surrounding the ulcer margin. Cross-sectional examination of the ulcer bed discloses a dense dermal infiltrate that contains many plasma cells and lymphocytes. There is endothelial cell proliferation and swelling, and spirochetes can be demonstrated throughout the epidermal and dermal areas. Despite this plasma cell response, and despite a rapid increase in serum T. pallidum-specific antibodies, cellular immunity undoubtedly plays a critical, and probably pivotal, role in controlling the syphilitic infection.

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