A 22-year-old homosexual male presented with fever, maculopapules and blisters on his face, trunk, and extremities. When the blisters broke, the skin ulcerated and then scabbed with overlying brown–black rupioid crusts within 3 weeks. When he was admitted to hospital, there were Multiple Skin crusted Ulcerations on the trunk (Fig. 1a) and extremities (Fig. 1b). There was a small ulcer with yellow discharge in the perineum, swelling of bilateral Subaxillary lymph nodes.
The examinations showed White Blood Cell (WBC) 11.98 × 109/L,neutrophils 9.82 × 109/L, C-reactive protein (CRP) 152 mg/dL, serum immunoglobulins and Anti-neutrophil cytoplasmic antibodies (ANCA) were normal, cultures of fungi, bacteria were negative. He was confirmed Human Immunodeficiency Virus(HIV) infection and his CD4+T cell counts were 117/µL, HIVRNA 4.22 × 105copies/ml. The biopsy pathology of right forearm lesion (Fig. 1c) showed an ulcer, dense inflammatory cells infiltrated in the dermis, including neutrophil, lymphocytes and histocytes, there was deep perivascular infiltration of lymphocytes and plasma cells. Malignant secondary syphilis was diagnosed according to the biopsy pathology, positive serum syphilis enzyme immunoassay (EIA) screening and high serum rapid plasma regain (RPR) test titer (1:64). After application of benzathine penicillin for 3 weeks, the rashes were in complete remission (Fig. 1d). RPR titer decreased (1:4) 8 months later.