Nodular Secondary Syphilis

Abstract

The great imitator of yesteryear is still with us, although syphilis is not a common disease in private office practice. When syphilis produces unusual skin lesions, the diagnosis is often delayed. We report an illustrative case of a middle-aged man who had a recent history of red nodules and indurated plaques on his arms and genitalia and in which the clinical diagnosis was lymphoma. The presence of syphilis was considered almost as an afterthought. Report of a Case A 57-year-old man originally consulted one of us (W.R.G.) because of a four-month history of asymptomatic nodules and plaques that had initially developed on the genitalia and, subsequently, involved the arms and hands. The patient's general health was excellent; he had no complaints of lymphadenopathy, fever, chills, weight loss, sore throat, skin ulcers, or respiratory problems. The initial diagnostic considerations were lymphoma, sarcoidosis, deep fungus infection, and, remotely, syphilis. Results of physical