REPORT OF A CASE
A 54-year-old, alcoholic, black woman presented with a 1-month history of papular lesions on her face, trunk, and limbs that had progressed to pustules and painful ulcers. Physical examination revealed pleomorphic skin lesions of the face, trunk, arms, and mucous membrane of the mouth. Morphologically, papules, pustules, and superficial and deep crusted ulcers were evident (Figure 1). The ulcers had well-defined erythematous edges without undermining (Figure 2). A biopsy specimen was obtained (Figure 3 and Figure 4).What is your diagnosis?
Noduloulcerative syphilis (malignant syphilis, lues maligna).
The biopsy specimen of an intact papule demonstrated a superficial and deep perivascular mixed infiltrate with lymphocytes, plasma cells, and epithelioid giant cells forming loose noncaseating granulomas throughout the dermis (Figures 3 and 4). Stains were negative for fungi, mycobacteria, and spirochetes.
Results of a VDRL
Merkert R. Generalized Ulcers. Arch Dermatol. 1997;133(8):1029-1030. doi:10.1001/archderm.1997.03890440111016