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Early syphilis can rarely cause erythema multiforme-type eruptions as well as triggering erythema multiforme (EM). EM-like lesions in secondary syphilis are characterized by clinical features of EM and laboratory tests consistent with secondary syphilis and the skin histology shows predominantly a plasma cell infiltrate with the presence of treponemes. When EM is triggered by early syphilis, the skin histology shows mixed inflammatory cells usually in the absence of treponemes in the skin lesion. There may also be mixed histology with the presence of treponemes in the absence of a plasma cell infiltrate and vice versa. We describe a case of secondary syphilis presenting as EM with bullae and histology showing EM features without a plasma cell infiltrate but positive for Treponema pallidum by immunohistochemical staining. The patient was also coinfected with cytomegalovirus, human immunodeficiency virus, and anal warts. The EM eruptions resolved with treatment for secondary syphilis with benzathine penicillin G. [ABSTRACT FROM AUTHOR]

Penile tuberculid successfully treated with anti-tuberculosis regimens Tuberculid of penis is extremely rare and easy to be misdiagnosed. Another type of tuberculid, named penile tuberculid, has been considered as a new entity, which usually shows papules, ulcerations, and scars on the penis (Dandale, Dhurat, & Ghate, [2]). [Extracted from the article]

A letter to the editor is presented which discusses a case study of a 40-year-old man who was evaluated for asymptomatic verrucous plaques in the upper gingiva and diagnosed with multiple verruciform xanthomas following his bone marrow transplantation.

Rationale: Systemic sclerosis (SSc) is a chronic and incurable autoimmune disease with high mortality rates, and skin fibrosis is one of distinguishing hallmarks in the pathogenesis. However, macrophage heterogeneity regulating skin fibrosis remain largely unknown. Methods: We established mouse disease model and performed single-cell RNA-sequencing (scRNA-seq) to resolve the dynamic and heterogenous characteristics of macrophages in skin fibrosis, and the role of TREM2-dependent macrophages in the pathological process was investigated using knockout mice and intraperitoneal transferring TREM2 + macrophages combining with functional assays. Results: We show that TREM2-expressing macrophages (TREM2 + MФs) accumulate in injured skin of mice treated by bleomycin (BLM) and human SSc, and their gene signatures and functional pathways are identified in the course of disease. Genetic ablation of Trem2 in mice globally accelerates and aggravates skin fibrosis, whereas transferring TREM2 hi macrophages improves and alleviates skin fibrosis. Amazingly, we found that disease-associated TREM2 + MФs in skin fibrosis exhibit overlapping signatures with fetal skin counterparts in mice and human to maintain skin homeostasis, but each has merits in skin remodeling and development respectively. Conclusion: This study identifies that TREM2 acts as a functional molecule and a major signaling by which macrophage subpopulations play a protective role against fibrosis, and disease-associated TREM2 + MФs in skin fibrosis might undergo a fetal-like reprogramming similar to fetal skin counterparts., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

Competing Interests: The authors declare no conflict of interest.