A male in his mid-40s presenting with diffuse lymphadenopathy and multiple pulmonary nodules.

Syphilis is a sexually transmitted infection produced by the spirochaete Treponema pallidum accompanied by a broad array of clinical features as the infection can disseminate systemically. Despite this clinical heterogeneity, acquired syphilis rarely manifests with pulmonary involvement. Since 2020, cases of syphilis have increased in the USA and commonly present without urogenital symptoms, making early detection challenging. We present the case of acquired secondary syphilis presenting with multiple solid pulmonary nodules and cervical, axillary and mediastinal lymphadenopathy.