Skin rash, dyspnea and bone pain: secondary syphilis.

A 50-year-old healthy male was seen for a 6-week history of right leg pain, occasional dyspnea and extensive non-pruritic skin rash in trunk and extremities (Fig. 1A). Physical examination revealed tachypnea with normal breath sounds and a non-confluent maculo-papular rash in the trunk and extremities. No adenopathies, mucosal or palmo-plantar lesions were evident. A contrast-enhanced CT scan showed presence of multiple axillary, hilar, and mediastinal lymphadenopathy (Fig. 1B), and bilateral and diffusely distributed pulmonary nodules with ground-glass density (Fig. 1C). Bone scintigraphy showed increased uptake of isotope on the right tibia (Fig. 1D). The Rapid Plasma Reagin test (RPR) was positive in 128 dilutions, with a positive Treponema pallidum microhemagglutination assay. Human immunodeficiency virus and serology of other