funDERMentals

Unusual Cause for Asymptomatic Rash

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TREATMENT
Although this man’s treatment is pending as of this writing, he is likely to receive a single dose of benzathine penicillin G (2.4 million units given IM). Penicillin is so much more effective than alternative treatments that it is strongly recommended even when the patient is allergic to it. (In those cases, desensitization is advised if the allergy is confirmed.) Other treatment options include ceftriaxone and doxycycline.

TAKE-HOME LEARNING POINTS
• Secondary syphilis can present with a generalized rash, the appearance of which can vary greatly from one case to another.

• Persistent, unexplained generalized rashes require biopsy to attempt to explain their origin.

• The presence of plasma cells predominating in the inflammatory infiltrate of a rash is highly suggestive of secondary syphilis.

• Indiscriminate and unprotected sex, particularly among men who have sex with men, correlates with risk for a number of conditions, including syphilis and HIV; this information must be sought in the history-taking process.

• Secondary syphilis must be reported to the local health department for investigation and definitive treatment.

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