Folliculotropic Non-Alopecic Secondary Syphilis

    September 2011 in “ Journal of the American Academy of Dermatology ”
    Jennifer Villaseñor‐Park, Emily Clark, Jonhan Ho, Joseph C. English
    TLDR A man with HIV had an unusual syphilis rash that looked like folliculitis but was cured with penicillin.
    In this case report, a 28-year-old HIV-positive African American man presented with a 4-day history of a generalized, pruritic, folliculocentric papular eruption, which was diagnosed as secondary syphilis. Despite a history of untreated HIV and previous syphilis treatment, the patient's skin biopsy initially suggested folliculitis rather than syphilis. However, serology confirmed syphilis with an RPR titer of 1:128, and treponemal stains on the biopsy revealed Treponema pallidum within the folliculitis areas. The eruption resolved with intramuscular penicillin. This case highlighted the diagnostic challenges of secondary syphilis in HIV-infected patients due to varied clinical and histopathologic presentations and the importance of biopsy with treponemal staining in such cases.
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