Leucoderma syphiliticum (LS), originally described as syphilide
pigmentaire, encompasses a spectrum of dyschromic lesions that emerge
during the course of secondary syphilis. Very few case reports are available in
modern biomedical databases. We present the case of a 57-year-old HIV-infected male
patient who presented with several round to oval, non-scaling, slightly raised and
well-demarcated hypochromic lesions scattered over the trunk, abdomen, dorsum, and
arms. Prior non-treponemal tests were negative for syphilis, but novel studies
yielded positive results at high titers. Skin lesions slowly regressed and the
hypochromic areas repigmented a few weeks after benzathine penicillin G treatment.
This is the first report of LS in an HIV-infected patient. A review of modern and
ancient literature was performed. The present case report emphasizes the need for
clinicians to have a heightened awareness of the varied and unusual clinical
phenotypes of syphilis.