CPC04 A rare rupioid rash

Abstract A 59-year-old man was referred to an urgent skin cancer dermatology clinic with a 4-month history of multiple lesions on his trunk, arms and face. The were painful, increasing in size, bleeding oozing serous fluid. patient reported being otherwise systemically well, mild eczema background high alcohol intake. On examination, he had striking rash numerous large rupioid plaques thick crusting surrounding erythema the trunk limbs. Smaller seen face neck. An infective aetiology favoured initial differential diagnosis ecthyma or atypical mycobacterial infection. biopsy taken, as well screening blood tests. Treponemal antibodies detected; rapid plasma reagin reactive (1 : 32), Serodia Treponema pallidum particle agglutination test 1280), suggesting active syphilis His demonstrated granulomatous inflammation, associated neutrophils, cells increased mucin deposition. Immunohistochemical staining for T. confirmed corkscrew-like organisms within basal epidermis upper dermis, consistent secondary syphilis; concurrent HIV infection negative. local genitourinary treatment benzylpenicillin full sexual health screening. word ‘rupioid’ describes oyster limpet shell-shaped keratotic is derived from Greek rhupos, meaning ‘filth’. Differential causes include cutaneous T-cell lymphoma, psoriasis, scabies syphilis. Rupioid also termed ‘malignant syphilis’ ‘Lues maligna’, describing well-demarcated thick, lamellate adherent crusts. It most frequently encountered HIV-positive patients; HIV-negative patients, comorbidities are diabetes, alcoholism, drug abuse, psoriasis hepatitis. Typically, there clinical improvement once antibiotic administered, but episodes Jarisch Herxheimer reaction reported. Syphilis diagnoses have tripled over last 10 years, cases heterosexual population rising rapidly. Dermatologists pivotal role play diagnosing primary syphilis, thereby preventing long-term sequelae tertiary controlling prevalence disease general population. This case highlights rare manifestation which, seen, will not be forgotten.