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clinical manifestations of early secondary syphilis include small papular, follicular, vesicular, corymbiform, psoriasiform rashes, while late secondary syphilis presents as nodular, annular, pustular, frambesiform, nodular-ulcerative form. 1,2 Annular secondary syphilis is mainly located at the mucocutaneous junction of the nasal alae and the oral commissure with the prevalence of 5.7-13.6%. 1 Therefore, the syphilitic lesion in our case is rare.The first line of treatment is the intramuscular injection of 2.4 million units of benzathine benzylpenicillin. Other treatments such as doxycycline can be prescribed. 3 Differential diagnosis of penile annular lesion includes annular lichen planus, annular psoriasis, granuloma annulare, and dermatophyte infection. 1 Histologically, typical secondary syphilis shows lichenoid psoriasiform dermatitis with lymphoplasma cell infiltration. However, the pathology can be variable or nonspecific. 4 Based on a previous history of homosexual contact, annular lesion on the penis, serological tests, and a good response to benzathine penicillin G treatment confirmed the diagnosis of penile annular secondary syphilis.In conclusion, annular syphilitic lesion on the penis is a rare manifestation of secondary syphilis at an unusual location, which can be misdiagnosed with other annular skin lesions.Therefore, we should recognize annular secondary syphilis in order to treat and prevent consequences of syphilis.

We present a novel case of an urticaria multiforme‐type drug reaction to the new cystic fibrosis medication Trikafta (elexacaftor + tezacaftor + ivacaftor). Equipped with this information, clinicians may be more prepared to counsel and treat patients if they experience similar symptoms after beginning Trikafta.

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