Secondary syphilis presenting as leukocytoclastic vasculitis in a 61-year-old man

We report a case of secondary syphilis presenting with an acute, rapidly progressive purpuric eruption mimicking leukocytoclastic vasculitis. A 61-year-old man presented with a 6-day history of nonpruritic rash on his chest and lower extremities associated with fatigue, sore throat, and night sweats. Examination revealed purpuric papules, extending from the dorsal feet to the hips; mucosal surfaces were not involved. A diagnosis of cutaneous small-vessel vasculitis was favored with possible triggers of IgA vasculitis. Initial work-up showed acute kidney injury and microscopic hematuria. Renal biopsy showed IgA nephropathy with mesangioproliferative glomerulonephritis. The patient's rash progressed to cover almost his entire body sparing palms and soles. Skin biopsy showed heavy perivascular lymphoplasmacytic infiltrate, capillary endothelial cell swelling, and sparse perivascular neutrophilic nuclear dust. Spirochetal stain highlighted scattered epidermal and dermal organisms.PMID:38478638 | DOI:10.5070/D329562402
Source: Dermatol Online J - Category: Dermatology Authors: Source Type: research