A 36 year old man presents with multiple copper-colored scaling maculo-papules on his palms and soles. He has been feeling run down for the past few weeks and on examination has mild-moderate inguinal adenopathy. He also has a very slight psoriasiform rash on his back that could pass for xerotic eczema. Mucous membranes and genitalia exam were normal. He reports no remembrance of any genital lesions. He reports multiple sexual partners over the past 8 months. RPR test was ordered.
What is your diagnosis?
Syphilis, Secondary (RPR positive)
Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidium. There are several stages including primary, secondary, latent,, late, and tertiary. There are also additional manifestations, such as neurosyphils and congenital syphilis. (Please see reference link below for additional information).
The patient here had secondary syphilis and the scaling maculo-papules on the palms and soles have been called (especially in Great Britain) “copper pennies” of secondary syphilis. He did not recall having a an earlier chancre, which is not uncommon. He was treated with 2.4 MU of benzathine penicillin G, IM. He did experience a moderate Jarish-Herxheimer reaction (fever, chills, headache and sore throat) that started 2 hours after the injection and lasted about 32 hours.
He was subsequently followed up with his primary care and was contacted by the Minnesota Department of Health (mandatory reporting) to evaluate and treat contacts.
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