Nodular secondary syphilis with associated granulomatous inflammation: case report and literature review

Authors

  • Carolyn Rysgaard,

    1. Department of Pathology, University of Iowa, Iowa City, IA, USA
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  • Erik Alexander,

    1. Dermatology Associates of Wisconsin, S.C., Wauwatosa, WI, USA
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  • Brian L. Swick

    Corresponding author
    1. Department of Pathology, University of Iowa, Iowa City, IA, USA
    2. Department of Dermatology, University of Iowa, Iowa City, IA, USA
    3. Iowa City Veterans Affairs Medical Center, Iowa City, IA, USA
    • Brian L. Swick, MD,

      University of Iowa, Department of Dermatology, 200 Hawkins Dr., 40025 PFP, Iowa City, IA 52242, USA

      Tel: +1 319 356 0342

      Fax: +1 319 356 8317

      e-mail: swickbrian@yahoo.com

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Abstract

A 62-year-old male presented with a 10-day history of a diffuse, erythematous papular rash sparing the palms and soles. Histopathologic examination of a skin lesion showed loose non-caseating granulomas in a lymphoplasmacytic background. Scattered spirochetes were identified by Treponema pallidum immunohistochemistry, in keeping with a diagnosis of secondary syphilis. Granulomatous inflammation in secondary syphilis is uncommon. A review of the literature reveals that the majority of prior reported cases of granulomatous secondary syphilis share similar characteristics to this case; namely, a papular or nodular clinical presentation, sparing of the palms and soles, and collections of epithelioid histiocytes with associated lymphocytes and variable numbers of plasma cells.

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