PMC5422738_01
a Pink, scaly plaque on the left abdomen. b Pink friable nodule on the right fourth toe without any involvement of the plantar toe. c Thin pink-violaceous papule on the right lower leg.
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F1
A 51-year-old transgender woman with a 20-year history of HIV currently on HAART (most recently CD4 485; viral load 209), diabetes mellitus type 2, hypertension, and asthma presented to the dermatology clinic with hypertrophic, pink, scaly plaques with some crusting, along with several pustules on the trunk, a thin pink-violaceous papule on the right lower leg, and a pink, friable exophytic nodule with a collarette of scale on the right fourth toe (Fig. 1).
a Biopsy of the left abdominal lesion showing both superficial and deep dense lymphohistiocytic and plasma cell infiltrate. Hematoxylin-eosin stain. b Immunohistochemistry for T. pallidum demonstrates spirochetes amidst the infiltrate confirming the diagnosis of syphilis. The PASD preparation and Fite stain did not reveal the presence of microbial pathogens. c Biopsy of the lesion on the right lower leg shows psoriasiform epidermal hyperplasia with interface dermatitis. The epidermis is surmounted by a parakeratotic scale. There is perivesicular plasma cell and granulomatous infiltrate. Hematoxylin-eosin stain. Immunohistochemistry for T. pallidum showed the presence of spirochetes within the dermal-epidermal junction.
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F2
Immunohistochemistry for T. pallidum was positive in all 3 biopsies (Fig. 2).