Syphilis, Phase I

Diagnosis: Syphilis, Phase I

Case submitted by Dao Truong to the dermRounds community.

Clinical Presentation

Clinical photograph(s) submitted for peer review and discussion.

Clinical History

Submitted by Dao Truong. Originally posted February 4, 2014.

Treatment

See case discussion.

Differential Diagnosis

• Herpes simplex (primary) • Pityriasis rosea (secondary) • Drug eruption (secondary) • Psoriasis (secondary) • Lichen planus • Tinea corporis • Lymphoma

Key Learnings

• "The Great Imitator" — syphilis mimics many dermatologic conditions • Primary: painless chancre at inoculation site (3-6 weeks after exposure) • Secondary: widespread maculopapular rash including palms and soles (pathognomonic), condylomata lata, mucous patches, moth-eaten alopecia • Tertiary: gummas, cardiovascular syphilis, neurosyphilis • RPR/VDRL for screening; FTA-ABS or TP-PA for confirmation • Jarisch-Herxheimer reaction: fever, headache, rash worsening within 24h of treatment — due to spirochete lysis • Any new patient with palmoplantar rash — always check RPR

Tags: syphilis, phase, dao truong