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• An indigent male patient presented with a widespread nodular eruption involving the torso and limbs. The differential diagnosis included nodular secondary syphilis, Kaposi's sarcoma, sarcoidosis, and lymphoma. Investigation confirmed secondary syphilis with positive cerebrospinal fluid serologic findings. Penicillin therapy produced a Jarisch-Herxheimer reaction despite pretreatment to diminish this. Discussion on the clinical features and treatment of syphilis is presented.(Arch Dermatol. 1989;125:1666-1669)