The Journal of Dermatology Vol. 20: 102-104,1993 Secondary Syphilis Mimicking Borderline (BL) Leprosy Virendra N. Sehgal, Sardari Lal, Sanjiv Jain, Sambit N. Bhattacharya, Devender M. Thappa and Kulbhusham B. Logani* Abstract A young woman with syphilids resembling borderline lepromatous (BL) leprosy is being described. This is yet another addition to its already well-documented manifestations. The high prevalence of leprosy and syphilis augments the epidemiological significance of the case. Key words: borderline lepromatous leprosy; secondary syphilis Introduction Developing countries continue to confront several tropical dermatoses, including leprosy and syphilis. The physician, therefore, should be well informed about clinical manifestations of these disorders. Syphilids in particular, may be baflling, because they may imitate several dermatoses (1, 2). A high index of suspicion may be of prime importance in forming the correct diagnosis. The current case documents the problem. Case Report A 26-year-old married woman reported with a rash over the skin of two months duration. It was preceded by low grade fever, malaise, headache, bodyache, and arthralgia. A couple of days later, light colored eruptions of varying sizes and shapes appeared over the chest, abdomen, and proximal parts of the extremities. New lesions continued to appear for a few days, while the existing ones continued to increase in size. The lesions were pruritic. Two weeks later, she had red, firm, raised eruptions varying in size from pinhead to pea. They were multiple and interspersed amongst the hypo- pigmented patches. Palms and soles were also affected. She had an irresistible desire to scratch. The patient and her spouse repeatedly denied any Received January 20, 1992; accepted for publication September 27,1992. Departments of Dermatology and S.T.D., *Pathology, Lady Hardinge Medical College and Associated SK and KS.C. Hospitals, New Delhi, India. Reprint requests to: Prof. Virendra N. Sehgal, MD; FNASc; FAMS; A/6, Panchwati, Opposite Azadpur Subzi Mandi, Delhi-lIO 033, India. Fig. 1. Hypopigmented scaly lesions. pre- or extra-marital sexual contact Cutaneous examination revealed hypopigment- ed/ erythematous plaques of varying sizes and shapes with well-defined borders in places. Some lesions were smooth; others were dry, rough, and scaly. There was no sensory deficit The lesions were generalized, bilateral, and symmetrical (Fig. 1). Erythematous, tender, papular eruptions varying in size from pinhead to pea were present among the hypopigmented plaques. They were multiple and uncountable. Palms and soles were also affected. The mucosae were normal. The peripheral nerves were not thickened or tender. There was gener- alized lymphadenopathy. The lymph nodes were small, firm, mobile, and rubbery in consistency.