SAEM Clinical Image Series: Guess Who’s Back?

Feb 22, 21
SAEM Clinical Image Series: Guess Who’s Back?


A 27-year-old male with no significant past medical history presented to the emergency department with one week of progressively worsening, non-pruritic, and intermittently painful rash to his bilateral dorsal and plantar feet. The patient also described lesions to his left inguinal region and scrotal sac. There was no fever, chills, nausea, vomiting, chest pain, or shortness of breath. The patient was sexually active with men and women, with inconsistent condom use.

Vitals: BP 161/100; HR 113

General: Alert, awake, oriented, and non-toxic without acute distress


  • Multiple copper lesions to the bilateral soles and dorsal surfaces of the feet
  • Scrotal and penile chancres and multiple wart-like lesions to the peri-rectal region

The remainder of the exam is unremarkable.

Rapid plasma reagin (RPR), general condition gonococcus (GC)/Chlamydia, and human immunodeficiency virus (HIV) serologies were sent.

Post-visit results showed:

Qualitative RPR: Positive

Quantitative RPR: 1:64

HIV and GC/Chlamydia: negative

Labs were otherwise normal.

Condylomata lata syphilis

A sexually transmitted infection caused by bacterium Treponema pallidum, is notoriously variable in its clinical presentation and has experienced a resurgence in recent years.

Primary syphilis can appear 3 to 90 days after exposure and manifests as a painless, non-pruritic chancre at the point of contact.

Secondary syphilis occurs 2 to 10 weeks after primary infection and commonly presents with systemic signs.

Take-Home Points

  • Syphilis has reemerged following a steady decline toward the end of the last century; it is therefore imperative that physicians be able to identify both typical and unusual cases given its recent resurgence and tendency to mimic other pathology (1, 2).
  • Condylomata lata is a cutaneous manifestation of secondary syphilis and are often misdiagnosed as genital warts or condylomata acuminata.
  1. Crouzy F, Alvarez V, Gex G, Troillet N. Unusual presentations and pitfalls of secondary syphilis: osteitis, pneumonia and malignancy. BMJ Case Rep. 2015;2015:bcr2015210618. Published 2015 Oct 26. doi:10.1136/bcr-2015-210618. PMID: 26504092
  2. Henao-Martínez AF, Johnson SC. Diagnostic tests for syphilis: New tests and new algorithms. Neurol Clin Pract. 2014;4(2):114–122. doi:10.1212/01.CPJ.0000435752.17621.48. PMID: 27606153

Author information

Sherin Mahrat

Sherin Mahrat

Medical Student
University of Illinois College of Medicine

The post SAEM Clinical Image Series: Guess Who’s Back? appeared first on ALiEM.

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