A 32-year-old heterosexual male, engaging in sexual risk behaviors, presented to the emergency department with a painful lesion in the sacrococcygeal region. Initially diagnosed as a pilonidal abscess, it was drained, but the condition showed poor evolution. Subsequent referral to the coloproctology clinic revealed a lesion with irregular edges, nodular characteristics, and a central crater, a biopsy confirmed the presence of Treponema pallidum. Due to its capacity to mimic other dermatological conditions and deviate from typical clinical patterns, atypical manifestations of syphilis can result in diagnostic errors and subsequent delays in receiving appropriate treatment.
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