Papulosquamous Eruption of the Trunk and Extremities Following a "Spider Bite" on the Penis

W.A. High, MD

Disclosures

December 09, 2003

Case Presentation

A 49-year-old black man.

The patient presented to the dermatology clinic for evaluation of a rash of 4 weeks' duration on his trunk and extremities. In taking a detailed history, it became evident that the eruption began 6 weeks after a "spider bite" on the penis, which the patient had not considered significant or related, and which had since healed.

He was seen in the emergency department 36 hours before his visit to the dermatology clinic and had been given antibiotics and a topical steroid. He had taken the antibiotic without incident. An extensive review of systems was unremarkable. The patient was unemployed and had no significant travel history. He reported a single monogamous female partner for the past 2 years. To his knowledge, he had never contracted a sexually transmitted disease.

Examination of the trunk and upper and lower extremities revealed a diffuse papulosquamous eruption (Figure 1). Closer examination of the right arm showed that the papules had a red-brown to copper color consistent with a dermal process, along with some epidermal scale (Figure 2). Palms and soles demonstrated some macular lesions. Lymphadenopathy was not appreciated. Examination of the mouth, groin, and axillae did not reveal any abnormalities. The patient reported diffuse alopecia, but no definitive areas of hair loss were identified.

(Courtesy of W.A. High)

(Courtesy of W.A. High)

Five-millimeter punch biopsies were obtained from papules on the back and right arm. Histopathologic examination revealed a dense plasmacytic infiltrate of the papillary dermis and superficial and deep perivascular areas (Figures 3 and 4). Special stains for organisms were negative.

(Courtesy of W.A. High)

(Courtesy of W.A. High)

Laboratory studies revealed a positive rapid plasma reagin (RPR;1:64) test, a positive anti-treponemal antibody test (MHA-TP), and negative HIV screening. Other testing, including a CBC, basic electrolytes, and liver function studies were within normal limits.

What Is Your Diagnosis?

  1. Disseminated gonorrhea

  2. Granuloma inguinale

  3. Lymphogranuloma venereum

  4. Secondary syphilis

View the correct answer.

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