By Gary M. White, MD

Lues maligna is a rare noduloulcerative form of secondary syphilis, an infection by the spirochete T. pallidum.


A prodrome of fever, headache, and myalgia is followed by a papulopustular eruption that ultimately forms necrotic ulcers and crusted lesions, some with rupiod scale. Patients may be severely ill. It is more common in HIV-infected patients, but may occur in non-HIV patients as well.


RPR or other serologic testing as well as special stains of skin biopsy confirms diagnosis.


An HIV test should be ordered. See secondary syphilis for treatment.


Malignant Syphilis in an Immunocompetent Patient. Actas Dermosifiliogr.2012;103:437-9 - Vol. 103


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