Volume 8 ; Issue 1 ; in Month : Jan-June (2025) Article No : 132
Shrayan Pal, Swarnali Maiti

Abstract

Secondary syphilis, a disease of clinical variability, often referred as “The Great Imitator”, can present as macules, papules, plaques, nodules or even as a solitary lesion. It is crucial to highlight these multiple faces of the disease, so that clinicians can consider syphilis in differential diagnosis of non-specific dermatoses, especially in high-risk patients. A 38 year old lady came to dermatology outpatient department with sudden onset asymptomatic red-to-violet rash all over the body since 2 weeks, first on trunk, followed by limbs, gradually progressive in size. She gave a history of unprotected sexual intercourse 4 months ago. On examination, multiple erythematous-to-violaceous non-tender scaly papules and plaques were noted with some juicy and targetoid lesions. Auspitz sign and koebner phenomenon were absent. Palms and soles, hair and nail, oral and genital mucosa were normal. Lymph nodes were not palpable. Due to clinical diagnostic dilemma biopsy was done which revealed hyperkeratosis with parakeratosis, acanthosis, spongiosis, capillary dialatation in papillary dermis and supra-papillary thinning with superficial and perivascular infiltrates of lymphocytes and lots of plasma cells. Intraepidermal neutrophilic microabscess was absent. TPHA was reactive. VDRL titre came 1: 128. Hence, the case was diagnosed as secondary syphilis. Secondary syphilis can have diverse clinical features and often missed by dermatologists. So, it is important to develop a clinical eye regarding multifaceted morphology and keep it as a differential, especially in high-risk patients with non-specific lesions. Hence, we have presented this case.

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