Nabita Bhattarai

1 Introduction Secondary syphilis, often termed “the great imitator,” is a systemic infection caused by Treponema pallidum following hematogenous dissemination [1]. The classic presentation includes asymptomatic copper-red macules or papules on the palms, soles, and mucous membranes, typically described as syphilitic roseola or papulosquamous eruptions [2]. Rarely, papulonodular lesions occur, with fewer than 30 cases reported in the last two decades [3].

FDE fixed drug eruption GBFDE generalized bullous FDE SJS/TEN Steven–Johnson syndrome/toxic epidermal necrolysis This case highlights generalized bullous fixed drug eruption caused by levocetirizine, initially misattributed to the more commonly implicated acetaminophen. Recurrent, site-specific lesions with increasing severity emphasize the need for accurate drug identification as prompt recognition and avoidance of the culprit drug can prevent potentially serious adverse reactions.

Mycoplasma pneumoniae-associated mucositis is a rare variant of Stevens-Johnson syndrome (SJS) characterized by two or more mucosal involvements without skin lesions. In the absence of cutaneous manifestations, the patient often seeks multiple specialists; a suspicion of Mycoplasma in such cases can avoid delay in diagnosis and adverse sequelae.