UMEM Educational Pearls


20 year old female complains of “itchy” rash to her foot x 1 week and recently the rash has spread to her other other foot and both hands (shown below). No past medical history, no fever or chills, no mucus membranes involvement, no new medications, no tick bites, no travel. She is also 16 weeks pregnant. What’s the diagnosis?


Answer: Secondary syphilis

  • The differential diagnosis for rash on the palms and soles is small and should always include syphilis.
  • The rash may be maculopapular, papular, annular, or pustular.
  • Syphilis easily crosses the placenta and fetal damage can occur; the extent of the damage depends upon its stage of development at the time of infection and the duration of untreated infection.
  • Without therapy, fetal infections  may result in miscarriage, stillbirth, growth restriction, hydrops fetalis, premature delivery, and neonatal death.
  • "The physician who knows syphilis knows medicine." -Sir William Osler


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