A previously well 34-year-old man presented with a 3-month history of multiple plaques on his face (Panel A), groin and penis (Panel B) There was no associated fever, malaise, headache, or arthralgia. The patient was heterosexual and reported a history of multiple unprotected sexual encounters over the preceding 2 years. Physical examination revealed multiple violaceous papules and annular plaques with slightly raised scaly borders scattered over the face, penis, legs, and feet. No lesions were observed on the mucosal surfaces, palms, or soles. Neither alopecia nor lymphadenopathy was found. A biopsy specimen obtained from the patient's lower right leg revealed a lichenoid, perivascular infiltrate with numerous plasma cells and lymphocytes. Plump endothelial cells lined the dilated blood vessels of the dermis. A rapid plasma reagin (RPR) test was positive, with a titer of 1:64, and a Treponema pallidum hemagglutination assay was reactive. A diagnosis of annular secondary syphilis was made. A serologic test for infection with the human immunodeficiency virus was negative. The patient reported no earlier history of chancres or genital ulceration. Treatment with penicillin G benzathine was initiated, and the cutaneous lesions resolved within 2 weeks. On repeat testing over the course of a year, his RPR test was negative.
The rashes for syphilis seem to come in multiple forms. Thanks for sharing!