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Case report

Blackwell
Oxford,
International
IJD

0011-9059
46
2007 The
UK
Publishing,
International
Journal of
Ltd.
Dermatology
Society of Dermatology

Multiple condylomata lata: a case report


Multiple
Hua
CASE
etREPORT
al.condylomata lata

Haikang Hua, MD, Xiaohong Zhu, MD, Lijia Yang, MD, Ming Li, MD, and
Pingdong Jiang, MD

From the Department of Dermatology and


Venereology, The Wuxi Second Affiliated
Hospital of Nanjing Medical University, Wuxi,
Jiangsu 214002, China, and Department of
Dermatology and Venereology, Wuxi No. 2
Peoples Hospital, Wuxi, Jiangsu 214002,
China

An unusual form of secondary syphilis was reported, characterized by multiple papules


involving the intertriginous areas. The skin biopsy was performed but was nondiagnostic. Later
on, serologic tests confirmed the diagnosis. This patient is presented to emphasize the
importance of considering syphilis in any patient with an at-risk sexual history and popular
verrucous lesions of the skin folds.

Correspondence
Haikang Hua, MD
Department of Dermatology and Venereology
Wuxi No. 2 Peoples Hospital
Wuxi
Jiangsu 214002
China
E-mail: huahaikang@yahoo.com.cn

Case Report

56

A 52-year-old man presented with a 1-month history of


enlarging asymptomatic papules involving the intertriginous
areas. He gave a history of unprotected extramarital sex
6 months earlier, but no genital lesions. He initially presented
to surgery clinic but was transferred to dermatology because
the skin biopsy was nondiagnostic.
Physical examination showed flat, gray or pink papules
involving the axilla and inguinal regions bilaterally, and the
perianal region (Fig. 1ac). There were soft, round or oval,
mushroom-like masses, 0.53 cm in diameter, with smooth,
moist surfaces; lesions were nontender but malodorous.
There was coalescence of the lesions involving the left axilla.
Unheated serum regain (USR) assay, a nontreponemal screening test, was positive in a titer of 1 : 16. Treponema pallidum
hemagglutination assay was then performed and was also
positive. Human immunodeficiency virus antibody test was
negative. Histopathologic exam revealed epidermal hyperplasia,
slight dilatation of dermal vessels with somewhat prominent
endothelium, and dermal infiltration with neutrophils and
numerous plasma cells (Fig. 2ad). The clinical history, physical
examination, serologic tests, and cutaneous histopathology
thus supported the diagnosis of secondary syphilis.
Procaine benzyl penicillin, 0.8 million units, was administered
daily for 15 days. The patient was advised to have quantitative
USR testing every 3 months for 1 year, every 6 months during
International Journal of Dermatology 2008, 47, 56 58

the following year, and annually thereafter. All lesions had


resolved by the time of his 3-month follow-up evaluation; he
refused further serologic testing and examination.
Discussion
Syphilis, a sexually transmitted disease caused by the spirochete Treponema pallidum, is a major worldwide, potentially
life-long health problem with the potential to manifest multiple
patterns of skin and visceral disease. Cutaneous lesions of
secondary syphilis may present in varied and often subtle
clinical forms, including macular and/or papular eruptions of
the trunk, palms, and soles; oral mucosal lesions; alopecia;
and condylomata lata.14
We report a man with multiple condylomata lata involving
axillary, inguinal, and perianal regions. Condylomata lata
commonly affect intertriginous skin, especially of the perineum,
which suffers heat, moisture, and friction. These lesions
uncommonly involve the axillary folds, eyelids, nasal and oral
cavity, skin between the breasts or digits, and the umbilical
area.5 The differential diagnosis of condylomata lata includes
verruca vulgaris, condylomata accuminatum, and familial
benign chronic pemphigus (Hailey-Hailey disease). This patient
is presented to emphasize the importance of considering
syphilis and performing the appropriate serologic tests in any
patient with an at-risk sexual history and papular verrucous
lesions of the skin folds.
2008 The International Society of Dermatology

Hua et al.

Multiple condylomata lata Case report

Figure 1 (a) Condylomata lata involving

the axilla. (b) Condylomata lata of the


inguinal region. (c) Condylomata lata of
the perianal region

Figure 2 (a) Epidermal hyperplasia

[hematoxylin and Eosin stain (H&E),


40]. (b) Dermal perivascular
inflammation with mononuclear cells
and dilated vessels with slight endothelial
cell prominence (H&E, 100).
(c) Numerous dermal plasma cells (H&E,
200). (d) Numerous dermal neutrophils
(H&E, 200)

2008 The International Society of Dermatology

International Journal of Dermatology 2008, 47, 5658

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Case report Multiple condylomata lata

References
1 Odom RB, James WD, Berger TG. Andrews Diseases of
the Skin: Clinical Dermatology, 9th edn. Philadelphia:
WB Saunders, 2000: 445466.
2 Brown DL, Frank JE. Diagnosis and management of syphilis.
Am Fam Physician 2003; 68: 283290.

International Journal of Dermatology 2008, 47, 56 58

Hua et al.

3 Rosen T, Hwong H. Pedal interdigital condylomata lata:


a rare sign of secondary syphilis. Sex Transm Dis 2001;
28: 184186.
4 Genc M, Ledger WJ. Syphilis in pregnancy. Sex Transm Infect
2000; 76: 7379.
5 Tham SN, Lee CT. Condyloma latum mimicking
keratoacanthoma in patient with secondary syphilis.
Genitourin Med 1987; 63: 339 340.

2008 The International Society of Dermatology