Fever, thoracic pain, skin lesions and Hampton hump

A chest X-ray showed opacity with fairly precise limits in the lower third of the left hemithorax similar to a Hampton hump, which consists of a shallow wedge-shaped opacity in the periphery of the lung with its base against the pleural surface, associated with diaphragmatic clamping ( figure 1 A-C). Tertiary syphilis, characterised by chronic inflammation and progressive gumma, may develop years after the initial contact. 1 2 The criteria for secondary syphilis are: (1) physical examination findings typical of secondary syphilis; (2) positive serological test for syphilis; (3) pulmonary abnormalities seen radiographically with or without signs and associated with pulmonary symptoms; (4) exclusion of other lung diseases; and (5) response to treatment with disappearance of the radiological findings. 3 In this case, all stains to identify T pallidum were negative and the skin lesion resembled gummatous syphilis.