Corymbose Syphilis

A 35-year-old Filipino otherwise healthy women presented with a one-month history of symptomless erythematous papules over the trunk and limbs. Lesions consisted of a large central papule surrounded by satellite papules extended on a rounded diameter measuring 5-15 cm (Figure1A-C). No evidence of mucosal lesions was documented. The patient had fever, fatigue and generalized lymphadenopathy. History of unprotected sexual activity with multiple partners and negative previous syphilis serologies were reported by the patient. Hepatitis B and C and HIV antibodies were negative. Venereal Disease Research Laboratory (VDRL)(1:128), Treponema Pallidum Hemagglutination test (TPHA)(1:2048), total antibodies and IgM anti Treponema Pallidum were positive. Hepatitis B and C and HIV antibodies were negative. Laboratory investigations showed an increased erythrocyte sedimentation rate (34 mm, n.v. 0-15 mm), C reactive protein (13.8 mg/L, n.v. <5 mg/L) and mild monocytosis (1.1×109/L, n.v. 0.2–0.8×109/L). Chest X-ray and abdominal ultrasound did not reveal abnormalities. Histological examination showed a superficial and deep inflammatory infiltrate with sarcoidei-like granulomas characterized by many plasma cells (Figure1D). These findings were consistent with syphilis. She was treated with Benzathine-penicillin, three doses of 2.4 million units intramuscular weekly. A complete resolution of clinical manifestations and a fourfold decrease in VDRL titer was observed after 3 months. Syphilis may rarely have a “corymbo” appearance, i.e. reminiscent of a flat-topped flower cluster in which the individual flower stalks grow upward from various point of the main stem to the same height.1-2