A 54-year-old man presented with persistent annular plaques located exclusively on his upper arms. Each of the foci had a raised indurated margin with central atrophy (Figure a, 03/2018). Examination of biopsy tissue showed numerous macrophages, multinuclear giant cells, lymphocytes, and plasma cells, indicating an infectious process. Serology demonstrated syphilis (with positive Treponema pallidum particle agglutination test and Western blot). The patient received intramuscular injections of 2.4 million units of tardicillin on days 1, 8, and 15. The gummas healed, leaving large hypopigmented scars (Figure b, 02/2019).The serum titer of cardiolipin antibodies (VDRL test) was much lower 6 weeks later. The diagnosis of tertiary syphilis with cutaneous gummas should be followed by immediate exclusion of involvement of any other organs (cardiovascular system, nervous system, eyes, liver, bones, joints). The incidence in Germany has increased to over nine registrations per 100 000 inhabitants. If left untreated, the mortality is up to 50–60%. Contact tracing is advised, particularly with regard to congenital infection with syphilis.
Figure.
M. Karsten, D. Hildenhagen,Universitätsklinikum Leipzig
Translated from the orignal German by David Roseveare.
Cite this as: Reschke R, Kunz M, Ziemer M: Gummatous cutaneous syphilis.
Footnotes
Conflict of interest statement:
The authors declare that no conflict of interest exists.