Pityriasis lichenoides et varioliformis acuta-like secondary syphilis: a case report of a rare cutaneous presentation

Miguel Nogueira, Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal Ema Pos, Department of Infectious Diseases, Centro Hospitalar Universitário de Santo António, Porto, Portugal André Coelho, Department of Pathology, Centro Hospitalar Universitário de Santo António, Porto, Portugal Mónica Caetano, Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal Joel Reis, Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal

The diagnosis of secondary syphilis can be challenging for clinicians due to its diversified cutaneous presentations. This is particularly true for human immunodeficiency virus (HIV) coinfected patients, who may develop unusual clinical manifestations. We report a case of a 33-year-old male, with HIV-1 infection without treatment, who presented to the emergency department (ED) with a 3-month history of erythematous macules. In the week before presenting to the ED, the lesions had progressed to multiple generalized papulovesicles and papules with central necrosis and serohemorrhagic crust, some exhibiting a “collarette” scale. Nasal discharge, earache, and fever were also present. The clinical picture was compatible with the diagnosis of pityriasis lichenoides et varioliformis acuta (PLEVA). Complementary examinations confirmed the diagnosis of PLEVA-like secondary syphilis, and the patient was successfully treated with benzathine penicillin. Our case highlights the importance of being aware of this rare cutaneous presentation of syphilis.