LAUSR

worsening lymphadenopathy during a Jarisch-Herxheimer reaction, lymphatic involvement is one of the most characteristic features of syphilis. As secondary syphilis results in part from lymphatic dissemination of Treponema pallidum, it is plausible that this stage of syphilis could present with lesions in a sporotrichoid pattern, as seen in this case. We posit that two features may help differentiate sporotrichoid secondary syphilis from other sporotrichoid conditions: location on the head and neck and concurrent classic findings of syphilis. In the current case, the sporotrichoid pattern involved the postauricular, occipital, and posterior cervical lymph nodes. These lymph nodes are among the most commonly affected in secondary syphilis, unlike other sporotrichoid conditions which usually involve lymph nodes of the extremities. The other clue in this case was the presence of mucosal erosions and condyloma lata, both of which are known manifestations of secondary syphilis. From 2014 to 2018, the number of cases of primary and secondary syphilis in the United States increased by 71.4%. Given this rising incidence, we suggest that secondary syphilis be added to the sporotrichoid differential diagnosis, especially if lymph nodes of the head and neck are involved and classic features of syphilis are simultaneously present.