Benign nodular tertiary syphilis: a rare presenting manifestation of HIV infection.

Late cutaneous syphilis has become a rarity as a result of the effective treatment of early and latent syphilis with antibiotics. We report a heterosexual male who presented with multiple large annular plaques of two years duration. Skin biopsy revealed endarteritis and non-caseating granulomas in the dermis along with plasma cells. VDRL and TPHA were reactive. ELISA for HIV-1 antibodies was reactive. This is the first report of nodular tertiary syphilis as the presenting manifestation of HIV.