Scalp Nodularity Associated With Secondary Syphilis

HealthDay News — A rare case of secondary syphilis which primarily presented with multiple nodules on the scalp has been detailed in a case report published in the Journal of Dermatology.

Fan Li, from Sichuan University in Chengdu, China, and colleagues reported the case of a 51-year-old man who presented with a 2-month history of multiple nodules on his scalp. The skin lesions had initially developed as groups of small nodules over the parietal area; in the following weeks, they increased in size and number.

According to the authors, multiple, rounded yellow-red to dull-red non-tender nodules and masses measuring 0.5 to 3 cm in diameter were observed scattered over the patient’s scalp; some of these were scaly and some were crusted due to scratching. A well-defined, firm painless subcutaneous mass was seen on the left cervical region.

The results of routine blood, urine, and stool samples and of chest computed tomography and abdominal and pelvic cavity ultrasound were normal. An enlarged lymph node was identified with normal structure in the left neck; the diagnosis remained indefinite. The patient was referred 1 month later with papillary nodules at his right nasolabial fold and bilateral nasal vestibules, with condyloma lata around the anus. Nodular secondary syphilis was eventually diagnosed.

“Secondary syphilis, also termed the ‘great imitator,’ has extremely diverse manifestations, with cutaneous involvement in most cases,” the authors write. “Clinicians must be aware of syphilis because of its prevalence and diversity of clinical manifestation.”

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Li F, Wang T, Wang L. Secondary syphilis primarily presenting with multiple nodules on the scalp: case report and published work review [published online July 17, 2017]. J Dermatol. doi: 10.1111/1346-8138.13965.