Syphilis as Athlete’s Foot: “The Great Imitator” Strikes Again

Excerpt

A 51-year-old man with human immunodeficiency virus (HIV) infection presented with worsening bilateral foot pain and difficulty ambulating. Three weeks prior he was diagnosed with tinea pedis. Despite applying an antifungal cream to his feet, his symptoms progressed. Two weeks later he was prescribed an oral antifungal agent. His foot pain and rash continued to worsen until he was unable to bear weight. Examination showed flaking of the interdigital toe spaces with maceration of the soles (Fig. 1, star). Surrounding macules were noted (Fig. 1, arrows), prompting inspection of his palms, which showed similar lesions (Fig. 2, arrows). This raised suspicion for secondary syphilis. A rapid plasma reagin (RPR) test was positive at a titer of 1:256.

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