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The Great Imitator: Atypical Cutaneous Manifestations of Primary Syphilitic Chancre

Huizi Gong, Mengyin Wu, Jun Li*, Heyi Zheng*   

  1. Department of Dermatology and Venereology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China


Objective To evaluate 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 cases 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  All misdiagnosed female cases involved extragenital chancres presenting as erythema or erosive skin lesions on the nipple, misdiagnosed as Paget's disease or eczema. Missed or misdiagnosed male cases presented as multiple lesions/syphilitic balanitis, chancre 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  It is easy to miss or misdiagnose primary syphilis presenting with multiple lesions rather than a single chancre, at atypical locations, or with a nonreactive nontreponemal test result.

Key words: primary syphilis;, chancre, misdiagnosis

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