{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T04:11:10Z","timestamp":1781842270440,"version":"3.54.5"},"reference-count":21,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Warmia and Mazury"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infectious Disease Reports"],"abstract":"<jats:p>Background\/Objectives: Secondary syphilis typically presents with a non-pruritic maculopapular rash. However, vesicular and bullous manifestations are exceedingly rare in adults and may mimic autoimmune blistering diseases. The objective of this report is to describe atypical presentation of secondary syphilis with predominant vesiculobullous lesions and to emphasize the importance of including syphilis in the differential diagnosis of blistering skin diseases. Methods: We describe the case of a 46-year-old bisexual man with syphilis of unknown duration who presented with recurrent polymorphic skin eruptions, predominantly bullous and vesicular in nature. Clinical examination, serologic testing, and histopathologic evaluation were performed to establish the diagnosis. Results: Serologic tests confirmed active syphilis infection. A brief review of similar reported cases was conducted to highlight the clinical variability of vesiculobullous syphilis. Conclusions: Atypical vesiculobullous presentations of secondary syphilis pose significant diagnostic challenges and may be mistaken for autoimmune blistering disorders. Clinicians should maintain a high index of suspicion for syphilis in patients with polymorphic or blistering eruptions, particularly in those with risk factors for sexually transmitted infections. Awareness of these uncommon manifestations can facilitate timely diagnosis and appropriate treatment.<\/jats:p>","DOI":"10.3390\/idr17060143","type":"journal-article","created":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T09:58:42Z","timestamp":1763459922000},"page":"143","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Atypical Blistering Manifestation of Secondary Syphilis: Case Report and Review of Reported Cases"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5609-303X","authenticated-orcid":false,"given":"Agnieszka","family":"Markiewicz","sequence":"first","affiliation":[{"name":"Department and Clinic of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, University of Warmia and Mazury, 10-229 Olsztyn, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0626-8269","authenticated-orcid":false,"given":"Aleksandra","family":"Sk\u00f3rka","sequence":"additional","affiliation":[{"name":"Students Organization, Department and Clinic of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, University of Warmia and Mazury, 10-229 Olsztyn, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8372-0438","authenticated-orcid":false,"given":"Agnieszka","family":"Owczarczyk-Saczonek","sequence":"additional","affiliation":[{"name":"Department and Clinic of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, University of Warmia and Mazury, 10-229 Olsztyn, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1111\/jdv.16946","article-title":"2020 European guideline on the management of syphilis","volume":"35","author":"Janier","year":"2021","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_2","unstructured":"European Centre for Disease Prevention and Control (2025, July 01). Available online: http:\/\/www.ecdc.europa.eu."},{"key":"ref_3","unstructured":"World Health Organization (2025, July 01). WHO Guidelines for the Treatment of Treponema pallidum (Syphilis). Available online: https:\/\/www.who.int\/publications\/i\/item\/who-guidelines-for-the-treatment-of-treponema-pallidum-(syphilis)."},{"key":"ref_4","unstructured":"Miedzi\u0144ski, F. (1985). Choroby Sk\u00f3ry i Weneryczne, Pa\u0144stwowy Zak\u0142ad Wydawnictw Lekarskich."},{"key":"ref_5","unstructured":"Jab\u0142o\u0144ska, S. (1967). Choroby Weneryczne, Pa\u0144stwowy Zak\u0142ad Wydawnictw Lekarskich."},{"key":"ref_6","unstructured":"Walter, F. (1950). Choroby Weneryczne, Pa\u0144stwowy Zak\u0142ad Wydawnictw Lekarskich."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1111\/j.1365-4362.1987.tb00532.x","article-title":"Clinical manifestations of secondary syphilis","volume":"26","author":"Hira","year":"1987","journal-title":"Int. J. Dermatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1111\/ijd.12518","article-title":"The great imitator revisited: The spectrum of atypical cutaneous manifestations of secondary syphilis","volume":"53","author":"Balagula","year":"2014","journal-title":"Int. J. Dermatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1111\/j.1365-4362.1987.tb00537.x","article-title":"Pustular secondary syphilis","volume":"26","author":"Noppakun","year":"1987","journal-title":"Int. J. Dermatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1177\/09564624241309172","article-title":"Isolated initial clavus-like rash: A rare presentation of secondary syphilis","volume":"36","author":"Sun","year":"2025","journal-title":"Int. J. STD AIDS"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.clindermatol.2005.01.015","article-title":"Syphilis: Uncommon presentations in adults","volume":"23","author":"Dourmishev","year":"2005","journal-title":"Clin. Dermatol."},{"key":"ref_12","first-page":"e10774","article-title":"Cutaneous Secondary Syphilis Resembling Non-Melanoma Skin Cancer","volume":"12","author":"Stone","year":"2020","journal-title":"Cureus"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S127","DOI":"10.5021\/ad.2011.23.S1.S127","article-title":"Congenital syphilis presenting with a generalized bullous and pustular eruption in a premature newborn","volume":"23","author":"Kim","year":"2011","journal-title":"Ann. Dermatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.jdcr.2023.09.023","article-title":"A case of secondary syphilis presenting like pemphigus with positive direct immunofluorescence","volume":"42","author":"Stone","year":"2023","journal-title":"JAAD Case Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1111\/j.1468-3083.2008.02926.x","article-title":"Secondary syphilis mimicking pemphigus vulgaris","volume":"23","author":"Mignogna","year":"2009","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1111\/j.1365-2230.1992.tb02533.x","article-title":"Bullous secondary syphilis","volume":"17","author":"Lawrence","year":"1992","journal-title":"Clin. Exp. Dermatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/j.jdcr.2019.07.021","article-title":"A pemphigus-like presentation of secondary syphilis","volume":"5","author":"Kopelman","year":"2019","journal-title":"JAAD Case Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.jdcr.2024.07.039","article-title":"Comments on Stone et al, \u201cA case of secondary syphilis presenting like pemphigus with positive direct immunofluorescence\u201d","volume":"52","author":"Pacheco","year":"2024","journal-title":"JAAD Case Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1177\/0956462413495382","article-title":"Vesicular syphilid in a seropositive patient","volume":"24","author":"Arora","year":"2013","journal-title":"Int. J. STD AIDS"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/j.lpm.2010.11.019","article-title":"Syphilis secondaire bulleuse [Bullous secondary syphilis]","volume":"40","author":"Lourari","year":"2011","journal-title":"Presse Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1053\/j.jfas.2010.08.015","article-title":"Vesicobullous syphilis: A case involving an unusual cutaneous manifestation of secondary syphilis","volume":"50","author":"Gustaferro","year":"2011","journal-title":"J. Foot Ankle Surg."}],"container-title":["Infectious Disease Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7449\/17\/6\/143\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T10:52:16Z","timestamp":1763463136000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7449\/17\/6\/143"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,18]]},"references-count":21,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["idr17060143"],"URL":"https:\/\/doi.org\/10.3390\/idr17060143","relation":{},"ISSN":["2036-7449"],"issn-type":[{"value":"2036-7449","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,18]]}}}