Abstract
The cutaneous manifestations of SARS-CoV2 are variable, often presenting with overlapping features of other diagnostic entities. Patients with COVID-19 infection may present with papulovesicular rash, urticaria, painful acral papules, livedo reticularis, or petechiae. Similarly, secondary syphilis is characterized by significant clinical and pathologic polymorphism. The granulomatous reaction pattern in secondary syphilis is uncommon, and to our knowledge has yet to be reported in a patient with suspected resolving COVID-19 infection. Here, we present a 62-year-old male with a history of HIV and resolving upper respiratory tract symptoms suspicious for the sequalae of a proven COVID-19 infection who presented with a 10-day history of a generalized rash. The rash was characterized by erythematous, edematous plaques on the neck, trunk and proximal extremities with thin scale on the palms and soles. Clinically, an eczematous or psoriasiform process (psoriasis versus pityriasis rubra pilaris) was favored. Histopathologic examination demonstrated superficial and deep dermal lymphoplasmacytic inflammation with associated aggregates of histiocytes and multinucleated giant cells, consistent with a granulomatous component. Further workup with T. Pallidum immunostaining revealed numerous spirochetes. Thus, a diagnosis of granulomatous syphilis was rendered. The patients rash eventually dissipated upon treatment with penicillin. It is our aim to highlight the importance of maintaining a broad clinical and pathologic differential diagnosis during the COVID-19 global pandemic.
Financial Disclosure:
No current or relevant financial relationships exist.
