Secondary syphilis in a patient with renal transplant

Syphilis is a sexually acquired infection caused by the bacterium Treponema pallidum. The initial clinical manifestation is usually a sole and painless chancre at the site of inoculation (in HIV patients several chancres are frequent). This is termed primary syphilis [1]. The chancre usually heals spontaneously within a few weeks. If untreated, a haematogenous spreading of T. pallidum from the site of inoculation occurs and develops a secondary syphilis [2], characterized by a cutaneous rash, fever, headache, malaise and diffuse lymphadenopathy. The rash typically involves the palms (absence in 20% of patients with secondary syphilis) and soles, but it may also include mucosal surfaces. Lesions may be maculopapular, papular, annular or even pustular. Similar to primary disease, the acute symptoms of secondary syphilis typically resolve spontaneously in several weeks. When patients remain untreated, a late or tertiary syphilis may appear in 40% at any time from 1 to 30 years after primary infection [3], producing cardiovascular (aortitis), gummatous (nodular lesions most commonly in skin and bones) and central nervous system syphilis (neurosyphilis, particularly general paresis and tabes dorsalis).