Syphilis, the Great Imitator—Clinical and Dermoscopic Features of a Rare Presentation of Secondary Syphilis

Abstract

Syphilis is characterized by a wide range of variable clinical symptoms; therefore, it is often referred to as “The Great Imitator”. Here, we report the case of a 69-year-old hepatitis-C-positive MSM patient, who was admitted to our clinic due to a solitary firm painless erythematous maculopapular lesion with a central crater-like crust on the upper right thigh that occurred two months prior. The dermoscopy showed an erythematous, copper-colored, oval lesion with diffuse monomorphic dotted and glomerular vessels, central crust, and circular scaling (Biett’s sign). The histological findings ruled out neoplasia and described a plasma cell infiltrate and endothelial swelling. Finally, the combination of the dermoscopic image, histological findings and the additionally acquired knowledge about the sexual history of the patient at the second visit led to the diagnosis, which was then confirmed with serological tests. Dermoscopy may become a supportive tool to facilitate the recognition of secondary syphilis; however, the reporting of these atypical cases is crucial to highlight the many faces of the disease so that clinicians consider syphilis as part of the differential diagnosis of non-specific lesions.

Neurosyphilis With Concomitant Respiratory Failure: A Case Study and Treatment Considerations

“…With increasing rates of syphilis, clinicians should expect to encounter more cases, particularly among high-risk populations such as MSM and individuals with HIV infection. The rates of syphilis have steadily increased since the early 2000s reaching a new high of 176,713 cases in 2021 [ 1 ]. The presentation of neurosyphilis can vary widely and routine screening should be considered in MSM and persons with HIV to prevent an emerging syphilis epidemic.…”

“…Neurosyphilis, caused by Treponema pallidum , can manifest at any time following the initial infection. The incidence of syphilis has been steadily increasing, particularly among men who have sex with men (MSM) [ 1 , 2 ]. Syphilis is known as “the great imitator” due to its variable clinical presentation and diagnostic challenges [ 1 ].…”

“…The incidence of syphilis has been steadily increasing, particularly among men who have sex with men (MSM) [1,2]. Syphilis is known as "the great imitator" due to its variable clinical presentation and diagnostic challenges [1]. This case report highlights a patient diagnosed with neurosyphilis in the setting of underlying HIV infection who presented with type 2 respiratory failure and septic shock [3][4][5][6].…”

Oral Secondary Syphilis in an HIV-Positive Transgender Patient: A Case Report and Review of the Literature

“…The differential diagnosis of oral syphilis lesions includes drug-related ulcerations, psoriasis, tuberculosis, histoplasmosis, pemphigoid, lichen planus, and oral squamous cell carcinoma [24,25].…”

An Atypical Cutaneous and Histopathological Manifestation of Secondary Syphilis in an HIV-Positive Male: A Case Report

“…The diagnosis of syphilis according to its stage should be approached with caution because of the diverse range of symptoms that syphilis, also known as the "The Great Imitator," can present with [4]. This is important for all physicians to be aware of, including dermatologists, because syphilis diagnoses are becoming more common in non-STD focused clinical settings [5].…”