This case report describes a rare and unusual manifestation of syphilis in a 55-year-old transgender female with a history of breast implant surgery. The patient presented with a painless enlargement of the right breast, accompanied by pruritus and skin lesions. Initial misdiagnosis led to treatment for scabies, which worsened into diffuse erythroderma. Further examination revealed breast implant rupture and systemic lymphadenopathy. Surgical removal of the implant and seroma drainage was performed. Pathological findings showed chronic inflammation, with concerns about a cutaneous T-cell lymphoproliferative disorder, but no signs of malignancy were observed. Serological tests confirmed active syphilis with a positive TPHA titer and VDRL result. This case highlights the importance of considering infectious etiologies, such as syphilis, even in patients with atypical clinical presentations, including those involving breast implants and skin conditions. Timely diagnosis and appropriate management are critical to prevent systemic complications in similar cases.