Syphilitic gumma arising in association with foreign material

Until recently the number of patients with syphilis has been diminishing. Although that trend has reversed cases of tertiary syphilis are rare and often difficult to diagnose as a substantial number of patients will have a negative rapid plasma reagin. Histologically, cutaneous lesions in late stage syphilis exist in two forms, noduloulcerative and gummatous. Silver stains for spirochetes are almost invariably negative and, surprisingly, immunohistochemical stains are problematic as most lesions contain few, if any organisms. Presented here is a case of gummatous tertiary syphilis arising in association with foreign material deposited after a motor vehicle accident.