Chinese Medical Sciences Journal ›› 2021, Vol. 36 ›› Issue (4): 279-283.doi: 10.24920/003842

• Original Articles • Previous Articles     Next Articles

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
  • Received:2020-10-05 Published:2021-12-31 Online:2022-01-06
  • Contact: Jun Li,Heyi Zheng E-mail:lijun35@hotmail.com;zhenghy62@yahoo.com.cn
In this article, the authors describe 27 cases of atypical primary syphilitic chancre, including female cases with extragenital chancres presenting as erythema or erosive skin lesions on the nipple and male cases manifested as syphilitic balanitis or multiple chancres on the penis root and adjacent pubis, who were missed or misdiagnosed at first. The authors aimed to draw attention to primary syphilis presenting with multiple lesions, at atypical locations, or with a nonreactive nontreponemal test result.

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

Copyright © 2021 Chinese Academy of Medical Sciences.  京公安备110402430088  京ICP备06002729号-1  Powered by Magtech.

Supervised by National Health & Family Plan Commission of PRC

9 Dongdan Santiao, Dongcheng district, Beijing, 100730 China

Tel: 86-10-65105897  Fax:86-10-65133074 

E-mail: cmsj@cams.cn  www.cmsj.cams.cn

Copyright © 2018 Chinese Academy of Medical Sciences

All right reserved.

京公安备110402430088  京ICP备06002729号-1