Abstract

A 28 yo gentleman presented with numerous plum colored indurated asymptomatic nodules and plaques involving the scalp, face, trunk and extremities that began 1.5 months ago. The lesions clinically resembled those of a hematolymphoid neoplasm, such as cutaneous lymphoma or leukemia cutis. Punch biopsy taken from two skin lesions both revealed superficial and deep psoriasiform lichenoid infiltrate comprised of plasma cells and variable numbers of histiocytes. Immunohistochemical stain for treponemes was positive in the epithelium and endothelial cells. Laboratory studies revealed a reactive RPR titer of 1:1024. He was promptly treated with penicillin and within days started to appreciate lesion regression and improvement in his skin.

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