A previously healthy 54-year-old bisexual man presented with a 2-week history of generalized nonpruritic skin rash and painless genital ulcerations. He reported low-grade fever, and admitted having unprotected sexual intercourse. Cutaneous lesions were present on the face, scrotum, trunk and extremities, including palms and soles. He had erythematous papular and nodular lesions and many of them were vesiculated or developed ulcerated necrotic centers with thick crust.