Secondary syphilis was confirmed when the rapid plasma reagin came back with a titer of 1:512. The treponemal blood test was also positive and the HIV test was negative. The biopsy showed Treponema pallidum in the tissue.
The patient was called to come in for treatment. He admitted to being involved in unsafe sex with many partners while addicted to cocaine. Syphilis is the great imitator and while this particular pattern is not the most common pattern of secondary syphilis, it is helpful to be aware of the great variability in which secondary syphilis may present.
The patient was treated with a single IM injection of benzathine penicillin. Within one week, the eruption was gone and the patient continued with his drug treatment program. At a 6-month follow-up, he was sober and his RPR titer was down 4-fold.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Smith M. Cocaine. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:1000-1003.
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