Psoriasiform papules, condyloma lata, lung nodules and hepatitis: the enormous variability of secondary syphilis manifestations

Description

A 44-year-old man, married, consulted his general practitioner with a 5-day history of fever, myalgia, headache and dry cough. Physical examination demonstrated wheezes in lung auscultation and liver function tests revealed cholestatic hepatitis with no increase in inflammatory markers; abdominal ultrasound was normal and thorax tomography showed small areas of subpleural consolidation (figure 1) and infracentimetric mediastinal lymph nodes suggestive of infection. A hepatotropic viral infection was presumed and he was treated symptomatically with no improvement. He was admitted to the hospital 2 weeks later presenting with perianal condylomata lata and psoriasiform papules affecting the trunk, genitalia, palms and soles (figure 2). Serological markers of hepatitis A, B and C and HIVs were negative and alpha 1-antitrypsin deficiency, autoimmunity and iron or copper overload were excluded. Both serum venereal disease research laboratory (VDRL) and treponemic tests were positive, the former with a titre of 1:128, and...

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