Diffuse Maculopapular Rash: An Uncommon Cutaneous Presentation of Secondary Syphilis

Syphilis is a sexually acquired disease that can affect multiple organ systems. Secondary syphilis can cause a wide range of skin manifestations, leading to misdiagnoses. Herein, we present a patient who developed a diffuse maculopapular rash concerning for a drug reaction leading to a dermatology consult. The patient was found to have secondary syphilis confirmed with immunohistochemical staining on skin biopsy tissue and a positive rapid plasma reagin. Appropriate management with benzathine penicillin G led to significant improvement in the rash. Given the increasing incidence of syphilis, increased awareness of the disease is imperative so that it can be considered in all patients given the highly variable presentation and likely confusion, at least initially, with drug reaction with eosinophilia and systemic symptoms syndrome and other drug eruptions.