We report a case of a nodular granulomatous secondary syphilis histologically resembling tuberculids in a patient with positive quantiferon test and serology for syphilis. Polymerase chain reaction (PCR) analysis led to the diagnosis. We underline the usefulness of PCR in clinically and histologically doubtful cases in order to avoid misdiagnosis and delay treatment.
HookEW. Syphilis. The Lancet2017 Apr; 389(10078): 1550–1557.
2.
BalagulaYMatteiPLWiscoOJ, et al.The great imitator revisited: the spectrum of atypical cutaneous manifestations of secondary syphilis. Int J Dermatol2014 Dec; 53(12): 1434–1441.
3.
JinAMcLarneyBDHsuS, et al.Granulomatous secondary syphilis: Another diagnostic pitfall for the dermatopathologist. J Cutan Pathol2023 Mar; 50(3): 209–212.
4.
RysgaardCAlexanderESwickBL. Nodular secondary syphilis with associated granulomatous inflammation: case report and literature review. J Cutan Pathol2014 Apr; 41(4): 370–379.
5.
GlatzMAchermannYKerlK, et al.Nodular secondary syphilis in a woman. Case Rep2013 May 8; 2013: bcr2013009130
6.
HallenslebenNDLde VriesHJCLettingaKD, et al.Tuberculids: cutaneous indicator diseases of Mycobacterium tuberculosis infection in young patients. J Eur Acad Dermatol Venereol2016 Sep; 30(9): 1590–1593.
7.
WenhaiLJianzhongZCaoY. Detection of Treponema pallidum in skin lesions of secondary syphilis and characterization of the inflammatory infiltrate. Dermatology2004; 208(2): 94–97.
