Palmoplantar keratosis as a primary presentation of secondary syphilis

A 36-year-old man of Bangladeshi origin presented with a febrile illness, arthralgia,  generalised  lymphadenopathy  and  palmoplantar  keratosis.  Initially  the patient  denied  any  sexual  contact,  although  investigations  went  on  to  confirm  a diagnosis of secondary syphilis. Subsequently a sexual history was obtained which revealed  he  regularly  attended  male  saunas  and  had  receptive  anal  sexual intercourse.