International Journal of Dermatology

2008,

47

, 56–58 © 2008

The International Society of Dermatology

56

An unusual form of secondary syphilis was reported, characterized by multiple papules

involving the intertriginous areas. The skin biopsy was performed but was nondiagnostic. Later

on, serologic tests confirmed the diagnosis. This patient is presented to emphasize the

importance of considering syphilis in any patient with an at-risk sexual history and popular

verrucous lesions of the skin folds.

Blackwell Publishing, Ltd.Oxford, UKIJDInternational Journal of Dermatology0011-9059© 2007 The International Society of Dermatology46

Case report

Multiple condylomata lata

Hua et al.CASE REPORT

Multiple condylomata lata: a case report

Haikang Hua,

MD

, Xiaohong Zhu,

MD

, Lijia Yang,

MD

, Ming Li,

MD

, and Pingdong Jiang,

MD

From the Department of Dermatology and Venereology, The Wuxi Second Affiliated Hospital of Nanjing Medical University, Wuxi, Jiangsu 214002, China, and Department of Dermatology and Venereology, Wuxi No. 2 People’s Hospital, Wuxi, Jiangsu 214002, China

Correspondence

Haikang Hua,

MD

Department of Dermatology and Venereology Wuxi No. 2 People’s Hospital Wuxi Jiangsu 214002 China E-mail: huahaikang@yahoo.com.cn

Case Report

A 52-year-old man presented with a 1-month history ofenlarging asymptomatic papules involving the intertriginousareas. He gave a history of unprotected extramarital sex6 months earlier, but no genital lesions. He initially presentedto surgery clinic but was transferred to dermatology becausethe skin biopsy was nondiagnostic.

Physical examination showed flat, gray or pink papulesinvolving the axilla and inguinal regions bilaterally, and theperianal region (Fig. 1a–c). There were soft, round or oval,mushroom-like masses, 0.5–3 cm in diameter, with smooth,moist surfaces; lesions were nontender but malodorous.There was coalescence of the lesions involving the left axilla.Unheated serum regain (USR) assay, a nontreponemal screen-ing test, was positive in a titer of 1 : 16. Treponema pallidumhemagglutination assay was then performed and was alsopositive. Human immunodeficiency virus antibody test wasnegative. Histopathologic exam revealed epidermal hyperplasia,slight dilatation of dermal vessels with somewhat prominentendothelium, and dermal infiltration with neutrophils andnumerous plasma cells (Fig. 2a–d). The clinical history, physicalexamination, serologic tests, and cutaneous histopathologythus supported the diagnosis of secondary syphilis.

Procaine benzyl penicillin, 0.8 million units, was administereddaily for 15 days. The patient was advised to have quantitativeUSR testing every 3 months for 1 year, every 6 months during

the following year, and annually thereafter. All lesions hadresolved by the time of his 3-month follow-up evaluation; herefused further serologic testing and examination.

Discussion

Syphilis, a sexually transmitted disease caused by the spiro-chete

Treponema pallidum

, is a major worldwide, potentiallylife-long health problem with the potential to manifest multiplepatterns of skin and visceral disease. Cutaneous lesions ofsecondary syphilis may present in varied and often subtleclinical forms, including macular and/or papular eruptions ofthe trunk, palms, and soles; oral mucosal lesions; alopecia;and condylomata lata.

1–4

We report a man with multiple condylomata lata involvingaxillary, inguinal, and perianal regions. Condylomata latacommonly affect intertriginous skin, especially of the perineum,which suffers heat, moisture, and friction. These lesionsuncommonly involve the axillary folds, eyelids, nasal and oralcavity, skin between the breasts or digits, and the umbilicalarea.

5

The differential diagnosis of condylomata lata includesverruca vulgaris, condylomata accuminatum, and familialbenign chronic pemphigus (Hailey-Hailey disease). This patientis presented to emphasize the importance of consideringsyphilis and performing the appropriate serologic tests in anypatient with an at-risk sexual history and papular verrucouslesions of the skin folds.

© 2008

The International Society of Dermatology International Journal of Dermatology

2008,

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, 56–58

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Hua

et al. Multiple condylomata lata

Case report

Figure 1 (a) Condylomata lata involving the axilla. (b) Condylomata lata of the inguinal region. (c) Condylomata lata of the perianal region

Figure 2 (a) Epidermal hyperplasia [hematoxylin and Eosin stain (H&E), ×40]. (b) Dermal perivascular inflammation with mononuclear cells and dilated vessels with slight endothelial cell prominence (H&E, ×100). (c) Numerous dermal plasma cells (H&E, ×200). (d) Numerous dermal neutrophils (H&E, ×200)

58 Case report

Multiple condylomata lata

Hua

et al.

International Journal of Dermatology

2008,

47

, 56–58 © 2008

The International Society of Dermatology

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