The Emergence of Tertiary Syphilis with Extensive Scalp Involvement: A Case Report

Case Report

Abstract

We report the case of a 47-year-old man who presented with extensive scalp lesions of approximately 1-year duration. Clinical examination revealed multiple erythematous, papular, pustular, crusted, and hyperpigmented lesions distributed across the scalp. Based on the clinical presentation and diagnostic evaluation, the patient was diagnosed with tertiary cutaneous syphilis with extensive scalp involvement. Appropriate serological investigations confirmed the diagnosis, and the patient received stage-appropriate treatment according to standard management recommendations. At follow-up, the scalp lesions improved clinically. This case highlights the importance of considering syphilis in the differential diagnosis of extensive and atypical scalp lesions. It emphasizes the need for appropriate serological confirmation and evaluation for systemic involvement.

Introduction

Syphilis is a sexually transmitted systemic infection caused by the spirochete Treponema pallidum. The infection has a variable clinical course and is traditionally classified into primary, secondary, latent, and tertiary stages [1,2]. Primary syphilis usually presents with a chancre at the site of inoculation, whereas secondary syphilis may produce generalized mucocutaneous manifestations, lymphadenopathy, and systemic symptoms [1,3]. Following the secondary stage, infection may enter a latent phase in which the patient has no obvious clinical manifestations. Without adequate treatment, some infected individuals may later develop complications involving the cardiovascular system, nervous system, or skin [2,4]. Tertiary syphilis is now relatively uncommon in settings where effective antimicrobial therapy is available, but it remains clinically important because its manifestations may be severe and diagnostically challenging. Cutaneous tertiary syphilis can manifest as nodules, plaques, noduloulcerative lesions, or gummas. These lesions may be destructive and may heal with scarring [4,5]. Because of their variable morphology, they can resemble inflammatory, infectious, granulomatous, or neoplastic disorders. Consequently, clinical examination alone may not be sufficient to establish the diagnosis [3,6]. Scalp involvement in late syphilis is unusual. Cutaneous lesions in this location may initially be interpreted as bacterial folliculitis, fungal infection, inflammatory follicular disease, or other dermatological conditions. A documented case of tertiary syphilitic gumma involving the scalp demonstrates that late syphilis should remain within the differential diagnosis of unusual scalp lesions [9]. We present a case of tertiary cutaneous syphilis presenting with extensive scalp involvement. This case report was prepared in accordance with the CARE (Case Report) guidelines [12]