Bouchelkia Iman, Tschen Jaime
Dermatology, Tilman J Fertitta Family College of Medicine, Houston, USA.
Dermatology, St. Joseph Dermatopathology, Houston, USA.
Cureus. 2025 Feb 28;17(2):e79845. doi: 10.7759/cureus.79845. eCollection 2025 Feb.
Secondary syphilis, often referred to as "The Great Imitator," is a diagnostic challenge due to its ability to mimic a range of dermatological conditions. Accurate differentiation is critical, particularly in patients with immunocompromised states, as misdiagnosis can lead to inappropriate management. This case highlights a unique presentation of lichen planus resembling secondary syphilis. A 68-year-old female undergoing chemotherapy for breast cancer presented with asymptomatic pink, scaly plaques on her palms and mucosal patches on her tongue. Concern for secondary syphilis prompted a serologic workup, including a rapid plasma reagin (RPR) test, which was non-reactive. Physical examination revealed no cervical, axillary, or inguinal lymphadenopathy, a hallmark feature of secondary syphilis. A 3 mm punch biopsy of the palmar lesions showed findings characteristic of lichen planus, including hyperkeratosis, hypergranulosis, and a band-like lymphocytic infiltrate. Special stains for spirochetes were negative. The patient was treated with apremilast (Otezla®) 30 mg orally twice daily and clobetasol 0.05% cream applied twice daily. After two weeks, significant improvement in the lesions was observed. This case underscores the diagnostic complexities of lichen planus mimicking secondary syphilis. Secondary syphilis commonly presents with systemic symptoms and lymphadenopathy, which were absent in this patient. Histopathologic confirmation played a pivotal role in differentiating the two conditions. This case adds to the growing body of knowledge on atypical presentations of lichen planus in immunocompromised patients. Clinicians should maintain a broad differential diagnosis for palmoplantar and mucosal lesions. Histopathology remains a cornerstone in confirming the diagnosis and guiding appropriate management.
二期梅毒常被称为“伟大的模仿者”，因其能够模仿一系列皮肤病状况，故而构成诊断挑战。准确鉴别至关重要，尤其是对于免疫功能低下的患者，因为误诊可能导致治疗不当。本病例突出显示了扁平苔藓类似二期梅毒的独特表现。一名68岁接受乳腺癌化疗的女性，手掌出现无症状的粉红色鳞屑斑，舌头出现黏膜斑。对二期梅毒的担忧促使进行了血清学检查，包括快速血浆反应素（RPR）试验，结果为阴性。体格检查未发现颈部、腋窝或腹股沟淋巴结肿大，而这是二期梅毒的一个标志性特征。对掌部病变进行3毫米的钻孔活检，显示出扁平苔藓的特征性表现，包括角化过度、颗粒层增厚以及带状淋巴细胞浸润。螺旋体特殊染色为阴性。该患者接受阿普米拉斯（Otezla®）口服，每日两次，每次30毫克，以及0.05%氯倍他索乳膏每日两次外用治疗。两周后，病变有显著改善。本病例强调了扁平苔藓模仿二期梅毒的诊断复杂性。二期梅毒通常伴有全身症状和淋巴结肿大，而该患者并无这些症状。组织病理学确诊在鉴别这两种疾病中起了关键作用。本病例为免疫功能低下患者扁平苔藓非典型表现的知识积累增添了内容。临床医生应对掌跖和黏膜病变保持广泛的鉴别诊断。组织病理学仍然是确诊和指导恰当治疗的基石。
