Lichenoid secondary syphilis

Abstract

Argentina Case 1 A married, heterosexual, promiscuous, 29‐year‐old white man had experienced an asymptomatic eruption on the trunk and left palm for the last 3 months. After 2 months, the trunk involvement disappeared, but 2 weeks later lip and tongue lesions developed. No history of genital ulcer was found. The physical examination revealed asymptomatic, violaceous, erythematous, flat‐topped papules in an annular pattern, 5–10 mm in size, on the left palm (Fig. 1). Painful vesicular lesions surrounded by a red halo, with erosions on the labial mucosa and defined areas of depapillation on the posterior aspect of the tongue, were observed. The genitalia and soles were free of lesions. The clinical findings suggested lichen planus or secondary syphilis. 1 Flat‐topped papules on the palm A biopsy specimen of the palm was consistent with a lichenoid dermatitis, with hyperkeratosis, parakeratosis, acanthosis, striking elongation of the rete ridges, leukocytic exocytosis, and sparse colloid bodies. A band‐like dense lymphomonocytic infiltrate without plasma cells was present throughout the papillary dermis. The infiltrate obscured the dermo‐epidermal interface (Fig. 2). A lip biopsy showed a subacute inflammatory dermatitis. Venereal Disease Research Laboratory (VDRL) titers were high (1/1024) and fluorescent treponemal antibody absorbed (FTA‐ABS) test was positive. Enzyme‐linked immunosorbent assay (ELISA) for human immunodeficiency virus (HIV) was negative. After two weekly doses of benzathine penicillin G (2.4 million units), all lesions cleared within 3 weeks. 2 Parakeratosis and acanthosis with thinning of the rete ridges. Lichenoid infiltrates of lymphocytes and monocytes (hematoxylin and eosin; original magnification ×40) Case 2 A 42‐year‐old white man had developed cutaneous lesions involving the trunk and extremities over the past 2 weeks. Anorexia, malaise, and generalized arthralgia were also noted. He was married and denied casual sexual partners. Itching, erythematous, flat‐topped papules with scaling and some crusts on the trunk and extremities were observed (Fig. 3). The palms and soles were free of lesions. The glans penis showed painless, erythematous, shallow erosions. Neck microlymphadenopathy was present. All other physical findings were normal. 3 Lichenoid eruption on the trunk FTA‐ABS and VDRL (1/1024) tests were reactive. ELISA for HIV was negative. The dark field microscopy examination of the glans penis exudate revealed Treponema pallidum with no spiraling motion. A biopsy specimen of the trunk showed a lichenoid dermatitis with increased numbers of perivascular and periadnexial plasma cells, in the superficial and deep dermis (Fig. 4). Two weekly doses of benzathine penicillin G 4 Superficial perivascular dermatitis; dermo‐epidermal interface lichenoid (hematoxylin and eosin; original magnification ×100) (2.4 million units) were given. All lesions faded in 3 weeks.

Secondary syphilis presenting as a lichen planus‐like rash

“…The most characteristic eruption in secondary syphilis is a symmetrically distributed, maculopapular rash with a coppery hue and sharply demarcated margins, usually involving the palms and soles 1 . Although it is well recognized that secondary syphilis can mimic many other conditions, 1 including pityriasis rosea, psoriasis, drug‐induced eruptions or sarcoidosis, lichenoid eruptions are uncommon 3,4 …”

The Immunopathobiology of Syphilis: The Manifestations and Course of Syphilis Are Determined by the Level of Delayed-Type Hypersensitivity

“…Hair loss can also occur (moth-eaten alopecia/alopecia syphilitica), typically affecting the scalp, but also the eyebrows or total body hair loss. Secondary syphilis has been termed the “great masquerader”, because its skin lesions show such diverse clinical and/or histologic morphologies, mimicking alopecia areata (130), bullous pemphigoid (131), cutaneous lymphoid hyperplasia (pseudolymphoma) (132–135), erythema multiforme (126, 136), granuloma annulare (43, 128, 137, 138), histiocytoma (34), leprosy (128, 139, 140), lichen planus (34, 126, 135, 141, 142), lupus erythematosus (43, 128, 143), mycosis fungoides (126, 144–146), pemphigus vulgaris (147), pityriasis lichenoides et varioliformis acuta (PLEVA) (34, 126, 135), pruritic (eczematous) dermatoses (126, 128, 148), psoriasis (34, 128, 149, 150), pustular psoriasis (34, 128), sarcoidosis (34, 135, 151–155), small vessel vasculitis (156), suppurative folliculitis (157), superficial thrombophlebitis (158), Sweet’s syndrome (128, 159), tinea imbricata and erythema annulare centrifugum (34, 160), and urticaria (104). Ulcerative nodular presentations are rare and can occur secondary to follicular pustules (157, 161), or an obliterative endarteritis, known as lues maligna (162, 163).…”

Annular lichenoid syphilis: A rare entity

“…[891011] Most of these cases including the present case had associated pruritus, which is otherwise an unusual symptom in S2 per se . [71011] Annular lichenoid lesions are even rare and have been reported previously on only two occasions.…”