A 35-YEAR-OLD man presented with a 2-week history of right eye pain and photophobia. His ocular history was unremarkable. His medical history was notable for thoracic shingles diagnosed 4 years prior to our seeing him. Results of serologic testing for human immunodeficiency virus antibodies were negative. Review of systems revealed a flulike illness concurrent with the onset of visual symptoms, as well as scaly erythematous papules and plaques on the palms (Figure 1) and soles (Figure 2) and a moth-eaten alopecia on the scalp (Figure 3) first noted 3 months prior to our seeing him.
Erythematous, scaly papules and plaques on the patient's palms.
Erythematous, scaly plaques on the patient's soles.
Moth-eaten alopecia on the patient's scalp.
The right fundus through a hazy, cell-filled anterior chamber and vitreous. Although not shown, peripheral areas of retinal necrosis and vasculitis were also present. Visual acuity was counting-fingers at 6 in.
Low-power photomicrograph of a hematoxylin-eosin–stained punch biopsy section obtained from the patient's scalp shows parakaratosis (arrowhead) and psoriasiform epidermal hyperplasia (arrows) (original magnification ×17).
High-power photomicrograph of the same hematoxylin-eosin–stained section seen in Figure 5 shows numerous infiltrating plasma cells (arrowheads) and scattered neutrophils (arrows) (original magnification ×100).
High-power photomicrograph of a Steiner silver–stained punch biopsy section obtained from the patient's scalp shows numerous spirochetes (arrowheads) (original magnification ×400).
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