Abstract:

The features of secondary syphilis are diverse both clinically and histopathologically. We report a case of a 38-year-old otherwise healthy woman who presented with a 2-month history of pruritic erythematous papules in rosary beads-like configuration on the upper back and posterior neck. There were also several small plaques on the scalp, an ulcerated plaque on the right mouth angle, and a dusky red maculopapular rash on the trunk and extremities. Palms and soles were not involved. Genital ulcers, hair loss and lymphadenopathies were not observed. A skin biopsy specimen from an annular lesion revealed marked psoriasiform epidermal hyperplasia with a superficial and deep perivascular as well as periadnexal lymphoplasmacytic infiltrate. A hair follicle showed a prominent perifollicular mixed inflammatory cell infiltrate with purulent scale crust on the surface and abundant neutrophils in the outer layer of the upper infundibulum. Immunohistochemical staining of Treponema pallidum revealed abundant spirochetes, mainly concentrated in the infundibulum where neutrophilic infiltration was present. Serological findings were negative for HIV screening but reactive for RPR/VDRL 1:64 and TPHA >1:5120. The rash improved one week after intramuscular benzathine penicillin G 2.4 MU injection. It is an unusual case of folliculotropic non-alopecic secondary syphilis presenting with unique features of rosary beads-like annular plaques clinically and psoriasiform dermatitis with follicular neutrophilic infiltration histopathologically. Awareness of such rare manifestations of secondary syphilis is helpful in rendering a correct diagnosis, thus enabling appropriate treatment promptly and preventing further contact spreading.

Financial Disclosure:
No current or relevant financial relationships exist.

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Julia Yu-Yun Lee