ANNULAR LESIONS RESTRICTED TO THE PENIS AND SCROTUM
A 30-year-old HIV1 positive male, presented with multiple erythematous-violaceous lesions, with elevated borders and an annular configuration, restricted to the penis and scrotum. The lesions were asymptomatic, evolved for 2 weeks, and clinically resembled granuloma annulare. He also had discrete erythematous papules in the trunk that appeared simultaneously.
A cutaneous biopsy was made and histopathology revealed a lichenoid infiltrate, mainly of plasma cells. Syphilis screening was positive, with a positive TPHA and a reactive RPR (titer of 1:256). The diagnosis of secondary syphilis was established and the patient was submitted to treatment with 3 weekly doses of intramuscular benzathine penicillin (2.4 million units).
HIV co-infection can affect the initial presentation, disease course and hamper syphilis diagnosis. Syphilis, known as “the great imitator”, must be kept in mind, even before unusual presentations, especially in HIV positive patients.
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