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April 1993

Rupia Syphilitica

Author Affiliations

Department of Medicine; Department of Pathology Episcopal Hospital Front Street and Lehigh Avenue Philadelphia, PA 19125

Arch Dermatol. 1993;129(4):514-515. doi:10.1001/archderm.1993.01680250130028

To the Editor.—  The recent dramatic rise in the incidence of syphilis challenges the medical community to recognize syphilis in all its guises.

Report of a Case.—  A 28-year-old woman was admitted to the hospital because of skin lesions. She had a history of intravenous drug abuse. One month before hospitalization, a papular lesion developed on the right side of her nose. The lesion continued to grow and became crusted and painful. She then noted additional similar lesions on her back.On examination, a crusted concretion was evident on the right side of her nose (Fig 1). Additional impetigolike lesions were noted on her back and upper extremities. She had anterior tibial tenderness and swelling.Culture of blood and of the crusted lesion was negative. The rapid plasma reagin was reactive in a titer of 1 to 64 dilutions, and the fluorescent treponemal antibody—absorption test showed positive findings. The skin