A Rash Diagnosis

June 2017 in “ The Medical Journal of Australia ”

Alana Christensen, Anushia Ashokan, David Gordon

hair loss cytomegalovirus syphilis Treponema pallidum benzylpenicillin prednisolone CMV

TLDR The man's rash, hair loss, and vision issues were due to syphilis, not CMV.

A 46-year-old man presented with a persistent rash, hair loss, and visual impairment initially misdiagnosed as acute cytomegalovirus (CMV) infection based on serology results. Further investigation revealed the correct diagnosis of syphilis, supported by positive Treponema pallidum particle agglutination (TPPA) and reactive rapid plasma reagin (RPR) tests. The patient was treated with intravenous benzylpenicillin and prednisolone, leading to significant improvement in symptoms. This case highlighted the importance of cautious interpretation of positive IgM serology results, which can often be false positives, and the necessity of confirming diagnoses with follow-up testing to demonstrate IgG seroconversion.

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A Rash Diagnosis

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