Picture of the Month—Quiz Case

A 16-year-old boy with a medical history of mild developmental delay was evaluated for several asymptomatic lesions that appeared progressively on his palms and soles during the last month. There was no associated fever, malaise, lethargy, headache, or arthralgia.

Physical examination revealed several red papules with hyperkeratotic surfaces, 5 to 16 mm in diameter, located on both palms and soles without crossing the palmar creases (Figure 1). Some isolated lesions were noted on his wrists and ankles. Thorough examination revealed a subtle, nonpruritic, reddish macular eruption distributed symmetrically on his trunk and extremities (Figure 2). Superficial painless lesions on the penis were also noted, as well as annular erythematous papules on the lateral aspects of his tongue (Figure 3). There was no visceromegaly, but generalized, nontender lymphadenopathy was present.

Figure 1. 

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Red papules with hyperkeratotic surface had developed on the patient's palms (A) and soles, including the inner aspect of his feet (B), during the last month.

Figure 2. 

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An asymptomatic reddish macular eruption on the patient's trunk was detected during physical examination.

Figure 3. 

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Annular erythematous papules were present on the lateral aspects of the patient's tongue.

What is your diagnosis?