Syphilid showing a histological pattern of granulomatous inflammation

Syphilid represents a great variety of clinical and histological patterns. As such, sometimes it is difficult to make a differential diagnosis from other skin diseases. The histopathologic findings of syphilid are different, according to the clinical types; macular, maculopapular, papulosquamous, and nodular type. Characteristically, there is a marked perivascular infiltration of plasma cells and lymphocytes with endothelial cell swelling in the dermis. Herein, we report a case of syphilid showing the unusual histological pattern of granulomatous inflammation. A 45-year-old male presented with erythematous papules on the scalp, trunk, arms and inguinal area for 2 months. The biopsy specimen showed a chronic granulomatous inflammation with multinucleated giant cells in the dermis. Serologic test for syphilis showed a strong positive, and the patient was diagnosed with secondary syphilis. He was treated with benzathine penicillin G and the skin lesions have successfully disappeared.