“…6 Granulomatous inflammatory reactions, as in the case described, are more characteristic of late syphilis, but nodular lesions with granulomas without involvement of the palmae and plantae have also been described in secondary syphilis. [7][8][9] Neurological involvement can occur in stages II and III and the clinical presentation may be very diverse. High cardiolipin antibody titers, along with other factors such as HIV infection or late syphilis, have been described as predictive of neurologic involvement; in principle, neurologic involvement needs to be ruled out in the diagnosis of syphilis with vague neurologic, psychiatric, ocular or otologic symptoms such as headache, focal neurologic deficits or personality changes.…”