The Great Imitator: A Rare Case of Lues Maligna in an HIV-Positive Patient

Lues maligna is a rare form of secondary syphilis, which manifests as severe skin lesions and systemic symptoms. We report a case of a 54-year-old male, who had long standing history of human immune deficiency (HIV) infection. The patient presented with fever, chills, and fatigue, with associated ulcerated and scabbed nodules on the face, trunk, and extremities. He was not compliant with HIV treatment regimen and had previous history of treated syphilis. He was sexually active with a female partner. Work-up revealed elevated RPR titers (1:32), which was 1:1 five years prior. He was diagnosed with Lues maligna and was treated with 1 dose of intramuscular benzathine penicillin. Additionally, the lesions were superinfected with staphylococcus aureus which was treated. Syphilis presents a diagnostic challenge and remains the great imitator. Physicians should be vigilant of lues maligna diagnosis when skin lesions are suggestive.