3. A 43-year-old man presented with a rapidly enlarging ulcerated nodule on the right ankle with a necrotic and crusted center. He also had multiple red-brown papules on the trunk and extremities. Some of these lesions had central erosions, while others had surface scale. He was known to be HIV positive but had no lymphadenopathy.
Diagnosis: Lues maligna is used to describe a rare noduloulcerative form of secondary syphilis.1 It was first described in 18592 and has been associated with other disorders such as diabetes mellitus3 and chronic alcoholism.4 Patients usually are gravely ill and develop polymorphic ulcerating lesions. Facial and scalp involvement are common, but patients typically do not have palmoplantar involvement in conventional presentations of secondary syphilis.
…The patient’s rapid plasma reagin titer at the time of the fourth biopsy was 1:256, and appropriate treatment with penicillin resulted in complete clearance of the lesions in 3 to 4 weeks.
For more information on this case, see “Rapidly Enlarging Noduloulcerative Lesions.” Cutis. 2014;94(3):E20-E22.
Photograph and case description courtesy of Cutis. 2014;94(3):E20-E22.
Related article
Man, 54, With Delusions and Seizures
2011;21(4):20, 22, 24