The broad spectrum of clinical manifestations seen in certain infectious diseases often mimics the protean aspects of chronic inflammatory disorders. The frequent lack of specific clinical and laboratory features of a rheumatic disease, such as systemic lupus erythematosus (SLE), may cause confusion in the diagnostic process. We describe a patient who has secondary syphilis and shows signs and symptoms compatible with SLE.Case report. A 36-year-old white man presented with complaints of fevers and arthralgias of 2 months' duration. He noted a sore throat, low-grade fever, and low backache at the onset of symptoms. His private physician performed a throat culture the results of which were negative for P-streptococcus, and aspirin was prescribed.Over the intervening 2 months, the patient noted persistent diffuse arthralgias which were maximal in the wrists and knees and accompanied by morning stiffness. Intermittent fever to 39°C ensued. Small scales developed on the scalp, followed by patchy hair loss. Several small circular breaks in the skin were noted, as were two sores on the inner lower lip and gum. He reconsulted his private physician who performed laboratory tests that showed erythrocyte sedimentation rate (ESR) > 100 mm/hour and antinu- clear antibodies positive at 1 :80. A diagnosis of systemic lupus erythematosus was made, and conservative therapy with salicylates was begun.Because of his subsequent failure to improve while on this regimen, the patient was referred to Mayo Clinic by his local physician for consideration of additional treatment. Review of his history revealed an episode of hepatitis with jaundice. There was no history of pleurisy, photosensitivity, or Raynaud's phenomenon. Sexual preference was homosexual with several partners. He denied having previous genital lesions or known venereal disease.At the time of physical examination he was afebrile. Patchy hair loss was seen on the scalp ( Figure 1) along with alopecia of the pubis. Small ulcers were noted inside the lips. Scattered cervical, postauricular, and inguinal nodes were palpable. No active synovitis or splenomegaly was evident, and genital examination was unremarkable.Blood tests revealed hemoglobin of 10.8 gm/dl (mean cell volume 88.0p3), white blood cell count of 4,3OO/pl, and ESR 108 mm/hour. A peripheral smear showed mild aniswytosis and rouleaux formation. Serum protein electrophoresis included a gamma globulin count of 2.33 gm/dl. A blood chemistry profile, complement studies, fluorescent antinuclear antibody, anti-native DNA antibody, and test for rheumatoid factor were negative or normal. However, the hepatitis B surface antigen test was positive, and the syphilis serology test using the ART system (Technicon Instrument Corp., Tarrytown, NY) was reactive at 1:64 dilution.The diagnosis of syphilis was suspected, and a fluorescent treponemal antibody absorption (FTA-ABS) test for syphilis was 4 + reactive. Oral, rectal,
