Syphilis: Case Report and Update for Dermatologists

Abstract

An otherwise healthy 26-year-old woman presented with a one-month history of oval ulcers on the tongue and red-brown scaly papules on the palms, soles, trunk and arms. She did not recall a history of genital ulceration and did not have systemic symptoms. She had initially been diagnosed with hand, foot and mouth disease by her primary care physician but the eruption persisted prompting a referral to dermatology. She reported one regular male sexual partner for the past several years.

Based on clinical suspicion, syphilis serology was ordered and skin biopsy was performed on a palmar lesion. The Treponema pallidum enzyme immunoassay (EIA) was reactive, and the rapid plasma reagin (RPR) was positive at 1:128. HIV testing was negative. Skin biopsy revealed a lichenoid and perivascular dermatitis, with positive immunohistochemical stain for spirochetes, consistent with the clinical and serologic diagnosis of secondary syphilis. She was treated with 2.4 million units of intramuscular benzathine penicillin G at the British Columbia Centre for Disease control. Sexual partners were traced and notified.