Syphilis cornee mimicking lichen planus clinically and histologically

Area of Science:

• Dermatology
• Infectious Diseases
• Syphilology

Background:

• Secondary syphilis, a systemic infection, exhibits diverse mucocutaneous manifestations.
• Palmoplantar lesions in secondary syphilis are sometimes referred to as "syphilis cornee."
• Lichen planus is a common inflammatory condition affecting skin and mucous membranes.

Observation:

• A 32-year-old male presented with pruritic, lichenoid papules on the palms and soles.
• Associated findings included grayish-white papules on the buccal mucosa and glans penis.
• Initial diagnosis considered palmoplantar lichen planus with mucosal involvement.

Findings:

• Histopathology revealed interface dermatitis, initially supporting lichen planus.
• Further investigation, including syphilis serology, led to a revised diagnosis of syphilis cornee.
• The patient's presentation was an uncommon manifestation of secondary syphilis.

Implications:

• This case underscores the importance of considering secondary syphilis in the differential diagnosis of palmoplantar lesions.
• Syphilis cornee can present atypically, mimicking other dermatoses like lichen planus.
• A thorough clinical evaluation and appropriate serological testing are crucial for accurate diagnosis and management of deceptive syphilis presentations.