Abstract
A 5-year-old female presented with white, "wet" appearing lesions on her buttocks and perineum of unknown duration. The patient had an anxious affect, and the clinician suspected a sexually transmitted infection resulting from abuse. A punch biopsy was performed which demonstrated an acanthotic epidermis with spongiosis and reactive atypia. The dermis had a superficial lymphohistiocytic infiltrate with several scattered eosinophils. A T. Pallidum immunohistochemical stain was performed, which highlighted numerous spirochetes and the diagnosis of syphilis was established. While syphilis has notoriously protean clinical manifestations, typically cutaneous syhilis lesions are described as dry or scaly. The histologic findings are also unusual as eosinophils are typically not found in syphilis.
This unusual case highlights the need for a high index of suspicion for syphilis when a seuxally transmitted infection is in the clinical diffrential diagnosis. Ancillary tests including immunohistochemical stains and serology may be warranted even in the absence of typical clinical and histologic findings as the consquences of this diagnosis are profound.