Telltale skin lesions of syphilis, gonorrhea, human papillomavirus infection, and Haemophilus ducreyi infection.
Secondary Syphilis, Case 2
A 20-year-old woman complained of multiple nonpruritic lesions on her forearms and hands; the lesions had appeared suddenly, 2 weeks earlier. Examination revealed numerous erythematous annular macules and papules (A and B). A biopsy specimen showed scattered plasma cells, hyperkeratosis, parakeratosis, and aggregates of mononuclear cells in the papillary dermis. These findings favored a diagnosis of secondary syphilis, which was confirmed by a positive VDRL test. The patient was treated with a combination of penicillin G benzathine and penicillin G procaine, and the lesions resolved. However, follow-up will continue for several years to make sure that a complete cure is obtained.
Secondary syphilis is often called "the great imitator," because it may be mistaken for pityriasis rosea, drug eruption, lichen planus, or numerous other skin disorders. Whenever syphilis is suspected, a VDRL test must be ordered.
(Case and photographs courtesy of Jonathan S. Crane, DO, Mary Lou Courregé, MD, and David Ohashi, MD.)