alexa Granulomatous Syphilis: A Pattern to Remember. Case Report and Review of Literature
ISSN: 2327-5073

Clinical Microbiology: Open Access
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Case Report

Granulomatous Syphilis: A Pattern to Remember. Case Report and Review of Literature

Grace L Lee 1, Alejandro Agru 1,2, Henry K Wong1 and Priyadharsini Nagarajan3*

1Division of Dermatology, Department of Internal Medicine, The Ohio State University-Wexner Medical Center, Columbus, OH, USA

2Department of Pathology, The Ohio State University-Wexner Medical Center, Columbus, OH, USA

3Department of Pathology, Section of Dermatopathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

*Corresponding Author:
Priyadharsini Nagarajan
Department of Pathology, Section of Dermatopathology
University of Texas MD Anderson Cancer Center
1515 Holcombe Blvd, Unit 85, Houston, TX 77030, USA
Tel: 713-745-2367
E-mail: [email protected]

Received date: December 12, 2014; Accepted date: January 26, 2015; Published date: February 05, 2015

Citation: Lee GL, Gru AA, Wong HK, Nagarajan P (2015) Granulomatous Syphilis: A Pattern to Remember. Case Report and Review of Literature. Clin Microbial 4:184. doi: 10.4172/2327-5073.1000184

Copyright: © 2015 Lee GL, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



Granulomatous inflammation in secondary syphilis is rare and poses diagnostic challenges both on clinical grounds and histologically. We report a case of granulomatous syphilis in a 44-year-old woman that presented with an erythematous papulo-nodular rash involving her face, neck and upper portions of chest, back and arms that was initially diagnosed as urticaria and treated ineffectively with systemic steroids. No mucosal or genital lesions, involvement of soles and palms, or lymphadenopathy was present. Histopathologic examination revealed dense dermal perivascular and periadnexal inflammatory infiltrate composed of lymphocytes and plasma cells accompanied by prominent granulomatous inflammation. Anti-treponemal immunohistochemical study revealed spirochetes and along with positive serology, supporting the diagnosis of secondary syphilis. With an increasing number of reported syphilis cases recently, internists, infectious disease specialists, dermatologists and dermatopathologists alike should be aware of the unusual presentations of this great imitator. We also present a review of literature of cases of secondary syphilis that present in such unusual clinical and histologic phenotypes.


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