Secondary syphilis in a 55 year-old homosexual male

ABSTRACT

We report a case of a 55-year old sexually active homosexual male who presented with one month duration of erythematous, non-pruritic papules on the forehead, nape, scalp, chest, back, extremities and genitals and the presence of coppery-red, slightly scaling macules on the palms and soles. RPR (>116 dilution) and TPPA were reactive. A 4-mm skin punch biopsy revealed hyperplasia of the epidermis, focal areas of erythrocytic exocytosis with mild spongiosis and vacuolar degeneration of the basal cell layer, and many superficial and deep moderately dense perivascular granulomous inflammatory infilitrates consisting of histiocytes, lymphocytes, many plasma cells, some neutrophils, nuclear dusts and few eosinophils. The patient was given a single dose of 2.4M units of benzathine penicillin G, divided into each buttock. A repeat quantitative RPR was scheduled after 6 and 12 months to monitor the patient's titer.