万能模仿者：梅毒硬下疳的非典型皮肤表现

doi:10.24920/003842

摘要/Abstract

摘要：

目的本研究探讨了梅毒硬下疳误诊的原因,以期加强临床医师对此病不典型特征的认识。
方法我们纳入了27例因临床表现不典型导致误诊和漏诊的梅毒硬下疳患者。
结果女性患者的不典型表现主要为生殖器外的乳头红斑或糜烂性皮损,易被误诊为Paget病或湿疹。男性患者的不典型表现主要有多发性病变、梅毒龟头炎及非典型部位（如阴茎根部及邻近耻骨部位）的硬下疳。此外,非梅毒螺旋体试验阴性的患者也容易被漏诊或误诊。
结论梅毒硬下疳的非典型表现多种多样,主要包括多发性病变、非典型部位、非梅毒螺旋体检测结果阴性,临床医师需警惕由此导致的漏诊或误诊。

关键词: 初期梅毒, 梅毒硬下疳, 误诊

Abstract:

Objective To analyze the reasons of misdiagnosis of primary syphilitic chancre and strengthen the understanding of atypical features of this disease.
Methods A case series of twenty-seven challenging primary syphilis patients who were not immediately recognized as chancre was included in our study. The clinical data including the patients’ age, sex, skin lesions, HIV status, syphilis serologic test results, treatment, and follow-up results were collected. Hematoxylin-eosin and immunohistochemistry staining of skin biopsy sections were reviewed.
Results Four female cases with extragenital chancres presenting as erythema or erosive skin lesions on the nipple were misdiagnosed as Paget’s disease or eczema. The disorder of missed or misdiagnosed male cases manifested as syphilitic balanitis or multiple chancres on the penis root and adjacent pubis rather than coronal sulcus or frenum. Patients with nonreactive nontreponemal tests at initial presentation were also easily missed or misdiagnosed.
Conclusion Primary syphilis presenting as multiple lesions rather than a single chancre, at atypical locations, or with a nonreactive nontreponemal test result, tends to be missed or misdiagnosed.

Key words: primary syphilis, chancre, misdiagnosis

Huizi Gong, Mengyin Wu, Jun Li, Heyi Zheng. The Great Imitator: Atypical Cutaneous Manifestations of Primary Syphilitic Chancre[J].Chinese Medical Sciences Journal, 2021, 36(4): 279-283.

图/表 5

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Case	Sex	Age (yrs)	Clinical diagnosis	Lesion location	Skin lesion	Chancres’duration (weeks)	Chancres’ numbers	RPR titer
1	Male	38	Ulcer	Glans	Ulcer	3	1	0
2	Male	57	Paget’s disease	Root of the penis	Erosion	6	1	1:8
3	Female	33	Paget’s disease	Left nipple	Scaly erythema	12	1	≥1:32
4	Male	48	Paget’s disease	Root of the penis	Ulcer	8	1	≥1:32
5	Female	19	Paget’s disease	Bilateral nipples	Erosion	8	2	≥1:32
6	Male	36	Ulcer	Glans, scrotum	Ulcer	2	2	1:1
7	Male	58	Behcet’s disease	Penis, scrotum	Ulcer	16	3	≥1:32
8	Female	44	Eczema	Left nipple	Erosive erythema	2	1	1:8
9	Male	37	Scabies	Root of the penis	Nodules	12	2	0
10	Female	26	Behcet’s disease	Perineum	Ulcer	2	1	1:1
11	Male	32	Balanitis	Coronal sulcus	Erosion	4	Syphilitic balanitis	≥1:32
12	Male	28	Genital herpes	Scrotum	Erosion	1	3	1:4
13	Female	27	Ulcer	Vaginal orifice	Erosion	4	1	0
14	Male	19	Ulcer	Upper lip	Ulcer	4	1	0
15	Female	26	Vaginitis	Cervix uteri	Erosion	6	1	1:32
16	Female	27	Paget’s disease	Right nipple	Scaly erythema	6	1	1:16
17	Female	51	Ulcer	Perineum	Ulcer	3	1	≥1:32
18	Male	24	Folliculitis	Pubis	Ulcer	4	4	1:16
19	Male	22	Balanitis	Glans	Erosion	2	1	1:16
20	Male	34	Balanitis	Glans	Erythema	6	Syphilitic balanitis	1:32
21	Male	33	Balanitis	Glans	Erythema	3	Syphilitic balanitis	0
22	Male	35	Balanoposthitis	Glans and foreskin	Ulcer and erosion	2	Multiple	1:8
23	Male	46	Balanoposthitis	Glans and foreskin	Erythema	2	Syphilitic balanitis	1:4
24	Male	42	Ulcer	Prepuce	Ulcer	2	1	0
25	Female	27	Ulcer	Lower lip	Ulcer	6	1	≥1:32
26	Male	56	Balanoposthitis	Glans and foreskin	Erythema	12	Syphilitic balanitis	≥1:32
27	Male	40	Chancroid	Glans	Ulcer	3	1	0

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