Abstract

Syphilis is a disease caused by Treponema pallidum. The incidence of syphilis has decreased significantly in the 20th decade, however it has been on the rise in the past decade. Clinically, it presents as non-pruritic maculopapular rash in various forms such as annular, pustular, scaly. Nonspecific systemic symptoms such as fever, lymphadenopathy, headache and malaise may accompany. Microscopically, acanthosis, psoriasiform dermatitis with elongated rete ridges, prominent perivascular lymphocytic infiltrate with numerous plasma cells are notable. Although, there is no distinct features that distinguishes it from other entities. Herein, we report a 51-year-old male who presented with diffuse erythematous morbilliform mildly itching rash over his trunk that extends to his extremities. Clinical presentation was most consistent with mycosis fungoides (MF). Histopathologic analysis showed superficial perivascular and interstitial mixed inflammation with focal epidermotropism. Immunohistochemical staining for T cell markers (CD3, CD4, CD8, CD7, CD5, CD30) showed no aberrancy. A spirochete stain revealed presence of organisms in the epidermis. A diagnosis of erythrodermic syphilis was favored. Erythroderma is a term used for life threatening diffuse erythema. It may be result of an inflammatory dermatosis, drug related or neoplastic conditions. All these entities are clinically undistinguishable. A biopsy may be needed to elucidate the etiology. Syphilis may sometimes present with unusual clinical and histologic findings. In our case clinical and histopathological findings were highly suspicious for MF. It is important for dermatologists and dermatopathologists to recognize the unusual presentation of syphilis.

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