Papulonecrotic Eruption in a 44-Year-Old-Man

Abstract

A patient is described who presented with the acute onset of widely distributed necrotic papules mimicking pityriasis lichenoides et varioliformis acuta. A skin biopsy revealed granulomatous inflammation and spirochetes were demonstrated. Serologic testing confirmed infection with the Treponema pallidum. Syphilis is still a great imitator and its persistence as an infectious disease is reviewed.

Demonstration of Treponema pallidum by immunohistochemistry in a patient with secondary syphilis mimicking pityriasis lichenoides chronica

“…Two previous reports have presented patients with secondary syphilis mimicking pityriasis lichenoides as in our case 1,2 . Although one of these reports did not demonstrate T. pallidum directly from the skin lesions, pityriasis lichenoides‐like syphilid was strongly assumed as skin lesions began to clear with penicillin treatment.…”

Secondary Syphilis in a 12-Year-Old Girl Misdiagnosed as Pityriasis lichenoides et varioliformis acuta: A Case Report

“… 3 Only two cases of PLEVA-like secondary syphilis have been reported, one in a 33-year-old HIV-infected patient 4 and another in a 44-year-old HIV-negative patient. 5 Similarly, a few published papers have reported secondary syphilis that mimics PLC. 6 , 7 In the present case, we did not realize the possibility of syphilis at first because of the young age of the patient and the cutaneous manifestations such as relapsed systemic erythema and papules, necrotic crust and hyperpigmentation that were compatible with PLEVA, which hampered the diagnosis of this case.…”

Secondary syphilis with granulomatous histology. A diagnostic challenge

“…The secondary stage of syphilis has cutaneous findings in greater than 80% of cases (2). A high index of suspicion should be maintained when evaluating skin findings of uncertain aetiology (1,3). Although syphilis is thought to be a relatively uncommon presentation today, the World Health Organisation (WHO) estimates that worldwide in 2012, there were 18 million cases of syphilis in adolescents and adults aged 15 to 49, and 5.6 million new cases (4).…”

“…Cutaneous tuberculosis and syphilis were later added to the list of differential diagnoses. Although the histology of syphilis is frequently granulomatous in its tertiary stage, granulomatous inflammation in the secondary stage of syphilis is much more uncommon (3,(6)(7)(8)(9). This case illustrates the importance of excluding syphilis in either an atypical clinical presentation of what may initially appear a common inflammatory eruption such as pityriasis rosea, and in the case of granulomatous pathology of uncertain aetiology.…”