title: Nodular secondary syphilis in a woman.
abstract: We report the case of a 21-year-old woman with symmetrically distributed, ulcerated nodules and plaques on the face, neck and arms. Initial differential diagnoses included pyoderma or sarcoidosis based on the clinical presentation and histopathology with non-caseating granulomas. After inefficient treatment with topical and systemic fusidic acid and steroids, we diagnosed nodular secondary syphilis owing to positive serology and immunohistochemical staining of Treponema pallidum in lesional skin. After treatment with benzathine penicillin, skin lesions improved and antibody titres declined significantly within 3 months. Nodular skin lesions in secondary syphilis are rare with 15 reported cases within the last 20 years. Furthermore, the granulomatous histology is often misleading. Our patient's case suggests that the physicians should be aware of syphilis as a possible differential diagnosis also in patients outside a high-risk population for sexually transmitted diseases and with an unusual clinical presentation.
authors: Department of Dermatology, University Hospital Zurich, Zurich, Switzerland. glatz.martin@gmx.net
authors: M
authors: M
authors: Glatz
authors: Y
authors: Y
authors: Achermann
authors: K
authors: K
authors: Kerl
authors: P P
authors: PP
authors: Bosshard
authors: A
authors: A
authors: Cozzio
mesh_terms: D000328:Adult; D000906:Antibodies / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006099:Granuloma / Q000382:microbiology / Q000473:pathology*; D006801:Humans; D010401:Penicillin G Benzathine / Q000627:therapeutic use; D012867:Skin / Q000382:microbiology / Q000473:pathology*; D013587:Syphilis / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D013588:Syphilis Serodiagnosis; D013591:Syphilis, Cutaneous / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D014210:Treponema pallidum; D055815:Young Adult
chemical_list: D000906:Antibodies; D010401:Penicillin G Benzathine
references: Clin Dermatol. 2004 Nov-Dec;22(6):461-8
references: 15596316
references: Clin Dermatol. 2006 May-Jun;24(3):181-90
references: 16714199
references: Acta Derm Venereol. 2011 Jun;91(4):491-4
references: 21369679
references: Arch Dermatol. 1983 Aug;119(8):677-80
references: 6191721
references: Int J STD AIDS. 1991 Jul-Aug;2(4):280-4
references: 1911961
references: Sex Transm Infect. 2010 Feb;86(1):39-40
references: 19837729
references: Dermatol Online J. 2003 Feb;9(1):9
references: 12639467
references: Hautarzt. 2005 Dec;56(12):1160-3
references: 15645190
references: MMWR Recomm Rep. 2010 Dec 17;59(RR-12):1-110
references: 21160459
references: Int J STD AIDS. 2009 May;20(5):300-9
references: 19386965
references: Sex Transm Dis. 2010 Mar;37(3):153-8
references: 19910862
references: Eur J Dermatol. 2011 Jan-Feb;21(1):136-7
references: 21233073
references: Acta Dermatovenerol Alp Pannonica Adriat. 2010 Dec;19(4):27-30
references: 21390478
references: J Clin Pathol. 2008 Mar;61(3):390-5
references: 17557863
references: Dtsch Med Wochenschr. 2012 Aug;137(31-32):1560-4
references: 22872533
references: Int J Dermatol. 1995 Apr;34(4):240-3
references: 7790137
references: Can Med Assoc J. 1976 Mar 20;114(6):503
references: 1260584
references: Int J STD AIDS. 2010 Aug;21(8):537-45
references: 20975084
references: Clin Infect Dis. 2012 Dec;55(12):1615-22
references: 22955437
references: Dermatol Online J. 2006 Mar 30;12(3):20
references: 16638434
references: Arch Dermatol. 2008 Aug;144(8):1078-9
references: 18711100
references: Sex Transm Dis. 1980 Oct-Dec;7(4):161-4
references: 7455863
references: Clin Dermatol. 2005 Nov-Dec;23(6):555-64
references: 16325063