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A case of pulmonary nodules in a patient living with HIV diagnosed with secondary syphilis. We discuss a case of secondary syphilis with pulmonary involvement in a 45-year-old man who tested positive for HIV. He presented with dyspnoea, chest pain and a rash on his limbs and torso. A CT showed multiple bilateral necrotic lung nodules. A diagnosis of pulmonary syphilis was made due to his respiratory symptoms and imaging, his serological, histopathology findings, and the resolution of symptoms on treatment with benzathine penicillin.