Secondary syphilis primarily presenting with multiple nodules on the scalp: Case report and published work review

Abstract

Syphilis, a sexually transmitted disease caused by Treponema pallidum, manifests with a broad spectrum of clinical presentations that usually involves skin. Nodular secondary syphilis occurs rarely, and mostly manifests as disseminated papulonodules or plaques over the trunk and limbs. We report an extremely rare case of nodular secondary syphilis that primarily presented with multiple nodules on the scalp, resembling Rosai-Dorfman disease or cutaneous malignant metastasis. Immunohistochemistry confirmed T. pallidum spirochetes microscopically.

Multiple rapidly growing necrotic eruptions on the face

“…The differential diagnosis of malignant sysphilis should always include deep mycoses, tuberculosis and nontuberculous mycobacterial infection, cutaneous leishmaniasis, pyoderma gangrenosum, Wegener granulomatosis, lymphoproliferative disorders and other cutaneous malignancies. 2,3 Rarely, when the clinical presentations are atypical, as in our case, it is difficult to be sure whether the lesion itself is caused by syphilis or not, particularly if T. pallidum cannot be identified in the skin sample despite the positive serological findings and excellent response to treatment. In the past, it was thought that spirochaetes were absent from tissue samples of malignant syphilis.…”

“…In this case, it was challenging to diagnose syphilis based on the initial presentation because in most of the previously published cases, the skin lesions of malignant syphilis were described as being disseminated over the trunk and extremities. The differential diagnosis of malignant sysphilis should always include deep mycoses, tuberculosis and nontuberculous mycobacterial infection, cutaneous leishmaniasis, pyoderma gangrenosum, Wegener granulomatosis, lymphoproliferative disorders and other cutaneous malignancies …”

A rare case of secondary syphilis presenting with extensive cutaneous nodules and generalised lymphadenopathy

“…Furthermore, nodular secondary syphilis can be misdiagnosed as syphilitic nodules of the tertiary stage. However, patients with tertiary syphilis usually have the involvement of cardiovascular, central nervous and skeletal systems (7). The World Health Organization recommends benzathine penicillin G 2.4 million units once intramuscularly in the treatment of early syphilis (8).…”

“…The World Health Organization recommends benzathine penicillin G 2.4 million units once intramuscularly in the treatment of early syphilis (8). Besides, patients with nodular secondary syphilis who were treated with administration of benzathine penicillin G 2.4 million units weekly for two or three weeks have been reported (Table 1) (1)(2)(3)(4)6,7,9).…”

Syphilis—Cardiovascular Manifestations of the Great Imitator

“…Syphilis is a chronic systemic infection that may last for decades in a susceptible individual. Humans are the only natural host, there is no vaccine available, and clinical histories and presentations may be quite atypical . The recent increase in numbers of cases globally has been attributed to a variety of factors including increased high‐risk sexual activity, travel and migration, and social and economic changes that have reduced access to medical treatment .…”