A 33-year-old French white man presented with a 2-month history of a widespread papulonodular eruption. He had no history of syphilis, nor did he report recent genital, anal, or buccal ulcerations consistent with chancre of primary syphilis. He had had heterosexual extramarital sexual intercourse 2 years before but denied any extramarital relations since then.
The eruption consisted of infiltrated erythematous to violaceous papules and nodules, coalescent in infiltrated plaques on the trunk, limbs, and face, giving an almost leonine facies (Figure 1). Similar lesions were found on the penis, scrotum, and groin. No mucosal lesions were present. Palms and soles were free of lesions. Hair and nails were normal. Results of neurologic clinical examination were normal. Some painless inguinal bilateral enlarged lymph nodes were present. The patient mentioned a slight asthenia. There was no fever or weight loss.
Battistella M, Le Cleach L, Lacert A, Perrin P. Extensive Nodular Secondary Syphilis With Prozone Phenomenon. Arch Dermatol. 2008;144(8):1078-1079. doi:10.1001/archderm.144.8.1078