Secondary Syphilis | Dermatopathology

Secondary syphilis can develop in approximately Â¼ of patients with untreated infections and presents with systemic signs and symptoms including fatigue, fever, myalgia, loss of appetite and lymphadenopathy. Involvement of the gastrointestinal tract, liver, kidneys, musculoskeletal system, CSF and eyes can also occur. Skin findings include a diffuse symmetric rash of the trunk, extremities and palms and soles with occasional involvement of the oral and perineal mucosa. Patients can also present with alopecia. If untreated, this stage generally resolves spontaneously, may relapse or develop into tertiary syphilis.

Click images to begin the slideshow

Slide 1: 21 year old female. Left lower arm.<br><br>The biopsy shows a very dense infiltrate within the dermis. The infiltrate assumes a band-like lichenoid pattern superficially.

Slide 2: There is a very dense plasma cell rich infiltrate within the dermis. The infiltrate assumes a band-like lichenoid pattern superficially. There is extensive infiltration of the adventitial dermis, follicles and the eccrine apparatus by plasma cells.

Slide 3: This is a higher power view of the dense plasma cell rich infiltrate within the dermis with a band-like lichenoid pattern and extensive infiltration of the follicles and the eccrine apparatus.

Slide 4: There is extensive infiltration of the follicles and the eccrine apparatus by plasma cells.

Slide 5: Higher power view of extensive infiltration of the adventitial dermis by plasma cells.

Slide 6: There is extensive infiltration of the adventitial dermis by plasma cells.

Slide 7: The spirochete antibody preparation is extensively positive.<br><br>Diagnosis: secondary syphilis

Slide 8: There are many spirochetes with cork-screw morphology within the epidermis.