Secondary syphilis: a nodular presentation with granulomatous inflammation—a case report

Syphilis, caused by <i>Treponema pallidum</i>, is a re-emerging infectious disease with diverse clinical manifestations. While primary syphilis often goes unnoticed, secondary syphilis is characterized by systemic symptoms and variable skin lesions, earning it the epithet 'the great imitator'. Histologically, secondary syphilis typically shows a plasma cell-rich dermal infiltrate, whereas granulomatous inflammation is rare. This report describes a case of nodular secondary syphilis with granulomatous inflammation in a 22-year-old woman who presented with persistent erythematous nodules on the face. Initial mismanagement with corticosteroids delayed the diagnosis, which was later confirmed by histopathology and positive serologic tests. Treatment with benzathine penicillin G led to complete resolution of the lesions. The case highlights the importance of recognizing atypical presentations of syphilis, especially granulomatous forms, in the differential diagnosis. Serologic testing remains essential for confirmation, and benzathine penicillin is the treatment of choice for all stages of syphilis.