Secondary syphilis mimicking cutaneous lymphoma

Atypical features of secondary syphilis are more common in patients with human immunodeficiency virus infection. We report this case in which the clinical features, serology and response to therapy were clearly suggestive of secondary syphilis but histopathology raised concerns about cutaneous lymphoma. A 30-year-old male presented with history of fever and cough of one month duration. He was seropositive for human immunodeficiency virus infection one year back. He had discrete multiple papular and papulonodular patches all over the body. VDRL and TPHA tests were positive. HIV infection was confirmed by two ELISA tests. Skin biopsy report raised the possibility of lymphomatous infiltration. He was treated with penicillin and responded favourably. He was also instituted antiretroviral therapy later.