Ulceronecrotic Plaques, Patchy Scalp Alopecia and Visual Disturbance in a 46-Year-Old Man.

Int J DermatolJul 7, 2026 (epub)
Case ReportDermatologyInfectious DiseasesOphthalmologyPathology (Anatomic & Clinical)

Alex Majri, Austen Anderson, Jeremy Ng et al.

✦ AI-curated · Sources linked

Case in brief

A 46-year-old incarcerated man with chronic hepatitis C and a history of intravenous drug use developed a rapidly progressive, pruritic eruption across the scalp, trunk, and limbs, with patchy scalp hair loss and bilateral panuveitis. Examination showed erythematous papules and plaques with central necrosis, prominent scalp disease, and palmoplantar hyperkeratosis. Biopsy showed epidermal ulceration and a dense dermal lymphohistiocytic infiltrate; immunohistochemistry identified numerous spirochetes, and serology showed a markedly elevated non-treponemal titre. The findings established malignant syphilis (lues maligna).

What made this case unusual

The combination of ulceronecrotic plaques, prominent scalp involvement with patchy alopecia, and bilateral panuveitis accompanied this presentation of malignant syphilis.

Diagnostic / clinical pearl

In ulceronecrotic dermatoses with systemic features, correlate the clinical findings with biopsy and syphilis testing; immunohistochemistry may demonstrate spirochetes.

Source

PubMed · PMID 42415342

Published in Int J Dermatol. This summary was written by xxcode from the publication's abstract and metadata. It is not peer reviewed and is not a substitute for the original article. For clinical decisions, review the original publication.

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