Abstract

In certain epidemiological contexts, condyloma lata (CL) is an easily overlooked manifestation of syphilis and imitates condyloma acuminatum (CA). A 53-year-old man who was married for 6 years and monogamous, presented to the ER with a 2-day history of a “boil” on his buttock. Physical examination revealed a 2.3 cm tan-pink, velvety, moist, plaque with coliform morphology and serosanguinous drainage. The ER physician and dermatologist who performed the biopsy felt the lesion was a CA. Histologic sections revealed a broad, flat, smooth squamous proliferation with a thin and ulcerated stratum corneum, long fusing rete ridges, prominent neutrophilic spongiosis and intraepidermal microabscesses. Within the dermis there was a dense lymphoplasmacytic infiltrate and superficial vascular proliferation. Two pauci-inflammatory, papillomatous regions were present containing thick hyperkeratosis/parakeratosis and wedge-shaped hypergranulosis. Syphilis immunohistochemical stain demonstrated numerous spirochetes streaming through the epidermis. Subsequent RPR titers and syphilis antibodies were positive. A diagnosis CL was rendered. HIV testing was negative. Condyloma lata is uncommon and easily overlooked, especially when the history suggests that the epidemiological probability is low and features are reminiscent of more commonly encountered entities such as CA. Clinically, CL is broader, flatter, and tends to be more moist than CA. Histologically, pauci-inflammatory, papillomatous areas may imitate CA, but as a whole, CL has flatter and broader epidermal hyperplasia with more inflammation (dermal plasma cells, neutrophilic spongiosis and microabscesses). Without a high index of suspicion, CL may be mistaken for CA, leading to easily avoided long-term sequelae and a high likelihood of transmission to sexual partners. We present this case to increase awareness of possible pitfalls in the diagnosis of this CL.

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