Case Number : CT0125 Adam_Bates

I am struggling with this one, the overall histology as well as the clinical history makes me consider acrodermatitis chronica atrophicans in first place (maybe early presentation as atrophy is not present) but of course I would talk with the clinicians first, other thoughts were secondary syphilis (dont think so) and dermatophyte infection (doubt it) but would still perform special stains.

Thought of secondary syphilis but the biopsy is siperficial to assess depth of infiltrate
 

Fungal infection and secondary syphillis come to mind.
 

Difficult case, with an overall feature consistent with secondary syphilis...but so many epidermal and dermal neutrophils?  

Single lesion on instep also odd for syphilis, but can't come up with any other ideas!!
 

Secondary syphilis.  The spirochete antibody showed numerous organisms and the RPR is positive as well.  Patient is responding well to antibiotic.