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Images of Memorable Cases: Cases 55 & 56

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk

Cases_55_56-pres1-1.jpg Cases_55_56-pres1-2.jpg

A 23-year-old homosexual man had an intensely pruritic, papulonodular eruption over his arms and back (left image). A 52-year-old man with AIDS had reddish papules and nodules—some pustular—over his face, chest, arms, and back (right image).

55 & 56. Secondary syphilis

On dark field examination, the lesions in the homosexual man were teeming with spirochetes. Additionally, his fluorescent treponemal antibody absorption test was positive. The AIDS patient had a penile chancre and a positive serum test for syphilis. With penicillin therapy, the eruption in both patients rapidly resolved.

Dermatologic manifestations are the hallmark of secondary syphilis. Copper-red papules are most common, but macular, pustular, acneiform, psoriasiform, nodular, annular, or follicular variants can appear. The lesions characteristically do not itch, but as shown in the first patient, pruritus can be the dominant clinical feature.

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