If you attended ASDP this year, this case was a poster presented by my colleague Roy King. A young adult man presented with a history of prior treatment for tinea on the face, that did not improve with therapy. He later developed multiple crusted scaly papules on his trunk and extremities. The biopsy from the arm showed parakeratosis, crust, interface changes with scattered necrotic keratinocytes in the basal and spinous layers of the epidermis. The superficial dermis showed an interface and perivascular infiltrate of primarily small lymphocytes with few eosinophils, no plasma cells. These changes all seem to point to pityriasis lichenoides et varioliformis acuta (PLEVA). There was some clinical suspicion for secondary syphilis and so the anti-treponemal immunostain was performed to be certain. Low and behold it was loaded with spirochetes. Nothing ground breaking here, but since syphilis appears on the rise, just something to keep in mind when you’re staring down a supposed case of pityriasis lichenoides. Treponema pallidum is no friend to the dermatopathologist, or anyone for that matter.