ABSTRACT
This chapter presents the case study of a 32-year-old actor. A 32-year-old actor presents to the accident and emergency department with a 7-day history of malaise, fever, aching in his joints and neck, and a persistent headache. He has also noticed a rash on his palms and soles and is worried that he might have developed meningitis. There are multiple, small erythematous macules 1–4 mm in diameter and patches with mild superficial scale on his palms and plantar aspect of his feet. Fever, headache and a rash is a common combination of symptoms with a wide differential diagnosis. The rash of secondary syphilis classically affects the palms, soles and trunk, but may become widespread. Lesions start as small erythematous papules and macules that may become slightly scaly and form erythematous-to-pigmented patches. If patients present with a chancre, then a smear can be taken onto a glass slide for dark-field immunofluorescence microscopy to identify the spirochaetes.
