REPORT OF A CASE
A 27-year-old woman presented for evaluation of symptomless skin lesions that had appeared 2 months earlier on her abdomen, back, and face and had progressively grown. She felt otherwise healthy.On examination, erythematous-violaceous, firm, 1-cm nodules were seen on the abdomen, dorsal surfaces of the upper limbs, scalp, and face. On the abdomen and arms the nodules coalesced into two plaques with a smooth surface, approximately 5 × 10 cm wide (Fig 1). The plaque in the nasolabial fold had a vegetating appearance (Fig 2).A biopsy specimen was taken from a nodule on the right arm. Microscopic examination showed a dense, poorly demarcated but predominantly perivascular infiltrate in the reticular dermis (Fig 3) composed of lymphocytes, epithelioid histiocytic cells, and numerous plasma cells (Fig 4).What is your diagnosis?
DIAGNOSIS:
Tertiary (tubercular) syphilis.
LABORATORY EVALUATION
The serologic tests for syphilis showed