万能模仿者：梅毒硬下疳的非典型皮肤表现

巩慧子; 吴梦茵; 李军; 郑和义

doi:10.24920/003842

Your Location：

Home >

Browse articles >

万能模仿者：梅毒硬下疳的非典型皮肤表现

中国医学科学杂志（英文版） 2021年36卷第4期页码：279-283

Original Articles | Updated：2024-04-10

- 万能模仿者：梅毒硬下疳的非典型皮肤表现
- Affiliations：
  
  Department of Dermatology and Venereology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
- Author bio：
  
  *Jun Li, Tel: 86-10-69151502, E-mail: lijun35@hotmail.com;
  Heyi Zheng, zhenghy62@yahoo.com.cn
- Funds：
  
  Beijing Municipal Science and Technology Commission(Z191100006619011);Capital’s Funds for Health Improvement and Research(2020-2-4016)
- DOI：10.24920/003842
  中图分类号：
- 收稿日期：2020-10-05，
  
  网络出版日期：2021-10-16，
  
  纸质出版日期：2021-12-31
- Accepted：
Scan QR Code
巩慧子, 吴梦茵, 李军, 等. 万能模仿者：梅毒硬下疳的非典型皮肤表现[J]. 中国医学科学杂志（英文版）, 2021,36(4):279-283.

Gong Huizi, Wu Mengyin, Li Jun, et al. The Great Imitator: Atypical Cutaneous Manifestations of Primary Syphilitic Chancre[J]. Chinese medical sciences journal, 2021, 36(4): 279-283.
巩慧子, 吴梦茵, 李军, 等. 万能模仿者：梅毒硬下疳的非典型皮肤表现[J]. 中国医学科学杂志（英文版）, 2021,36(4):279-283. DOI： 10.24920/003842.

Gong Huizi, Wu Mengyin, Li Jun, et al. The Great Imitator: Atypical Cutaneous Manifestations of Primary Syphilitic Chancre[J]. Chinese medical sciences journal, 2021, 36(4): 279-283. DOI： 10.24920/003842.

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。

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.

关键词

Keywords

references

Yang S , Wu J , Ding C , et al . Epidemiological features of and changes in incidence of infectious diseases in China in the first decade after the SARS outbreak: an observational trend study . Lancet Infect Dis 2017 ; 17 ( 7 ): 716 - 25 . doi: 10.1016/S1473-3099(17)30227-X https://dx.doi.org/10.1016/S1473-3099(17)30227-X . DOI: 10.1016/S1473-3099(17)30227-X http://doi.org/10.1016/S1473-3099(17)30227-X https://linkinghub.elsevier.com/retrieve/pii/S147330991730227X https://linkinghub.elsevier.com/retrieve/pii/S147330991730227X

Ghanem KG , Campion EW , Ram S , et al . The modern epidemic of syphilis . N Engl J Med 2020 ; 382 ( 9 ): 845 - 54 . doi: 10.1056/NEJMra1901593 https://dx.doi.org/10.1056/NEJMra1901593 . DOI: 10.1056/NEJMra1901593 http://doi.org/10.1056/NEJMra1901593 http://www.nejm.org/doi/10.1056/NEJMra1901593 http://www.nejm.org/doi/10.1056/NEJMra1901593

Clement ME , Okeke NL , Hicks CB . Treatment of syphilis: a systematic review . JAMA 2014 ; 312 ( 18 ): 1905 - 17 . doi: 10.1001/jama.2014.13259 https://dx.doi.org/10.1001/jama.2014.13259 . DOI: 10.1001/jama.2014.13259 http://doi.org/10.1001/jama.2014.13259 http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2014.13259 http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2014.13259

Guerra LO , Valdés FV . Molecular diagnostic of syphilis . Enferm Infecc Microbiol Clin (Engl Ed) 2020 ; 38 ( Suppl 1 ): 7 - 11 . doi: 10.1016/j.eimc.2020.02.002 https://dx.doi.org/10.1016/j.eimc.2020.02.002 . DOI: 10.1016/j.eimc.2020.02.002 http://doi.org/10.1016/j.eimc.2020.02.002

Lum B , Sergent SR . Rapid Plasma Reagin. In: StatPearls [Intelnet]. Treasure Island (FL): StatPearls Publishing ; 2021 . Available from: http://www.ncbi.nlm.nih.gov/books/NBK557732/ http://www.ncbi.nlm.nih.gov/books/NBK557732/ http://www.ncbi.nlm.nih.gov/books/NBK557732/ .

Motlagh MN , Javid CG . Presentation of ocular syphilis in a HIV-positive patient with false-negative serologic screening . Case Rep Infect Dis 2019 ; 2019 : 8191724 . doi: 10.1155/2019/8191724 https://dx.doi.org/10.1155/2019/8191724 . DOI: 10.1155/2019/8191724 http://doi.org/10.1155/2019/8191724

Spydell LE . Congenital syphilis and the prozone phenomenon: a case study . Adv Neonatal Care 2018 ; 18 ( 6 ): 446 - 50 . doi: 10.1097/anc.0000000000000573 https://dx.doi.org/10.1097/anc.0000000000000573 . DOI: 10.1097/anc.0000000000000573 http://doi.org/10.1097/anc.0000000000000573 https://journals.lww.com/00149525-201812000-00006 https://journals.lww.com/00149525-201812000-00006

Chiu HY , Tsai TF . A crusted plaque on the right nipple . JAMA 2012 ; 308 ( 4 ): 403 - 4 . doi: 10.1001/jama.2012.7538 https://dx.doi.org/10.1001/jama.2012.7538 . DOI: 10.1001/jama.2012.7538 http://doi.org/10.1001/jama.2012.7538 http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2012.7538 http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2012.7538

Ma DL , Vano-Galvan S . Images in clinical medicine. Syphilitic chancres of the lips . N Engl J Med 2013 ; 368 ( 7 ): e8 . doi: 10.1056/NEJMicm1202329 https://dx.doi.org/10.1056/NEJMicm1202329 . DOI: 10.1056/NEJMicm1202329 http://doi.org/10.1056/NEJMicm1202329 http://www.nejm.org/doi/10.1056/NEJMicm1202329 http://www.nejm.org/doi/10.1056/NEJMicm1202329

Ficarra G , Carlos R . Syphilis: the renaissance of an old disease with oral implications . Head Neck Pathol 2009 ; 3 ( 3 ): 195 - 206 . doi: 10.1007/s12105-009-0127-0 https://dx.doi.org/10.1007/s12105-009-0127-0 . DOI: 10.1007/s12105-009-0127-0 http://doi.org/10.1007/s12105-009-0127-0 http://link.springer.com/10.1007/s12105-009-0127-0 http://link.springer.com/10.1007/s12105-009-0127-0

Dourmishev LA , Dourmishev AL . Syphilis: uncommon presentations in adults . Clin Dermatol 2005 ; 23 ( 6 ): 555 - 64 . doi: 10.1016/j.clindermatol. 2005.01.015 https://dx.doi.org/10.1016/j.clindermatol. 2005.01.015 . DOI: 10.1016/j.clindermatol. 2005.01.015 http://doi.org/10.1016/j.clindermatol. 2005.01.015

Otero-Rivas MM , Usero-Bárcena T , Rodríguez-Lojo R , et al . Multiple syphilitic chancre . Med Clin (Barc) 2018 ; 150 ( 2 ): e3 . doi: 10.1016/j.medcli.2017.03.011 https://dx.doi.org/10.1016/j.medcli.2017.03.011 . DOI: 10.1016/j.medcli.2017.03.011 http://doi.org/10.1016/j.medcli.2017.03.011 https://linkinghub.elsevier.com/retrieve/pii/S0025775317302324 https://linkinghub.elsevier.com/retrieve/pii/S0025775317302324

Katz AR , Johnson DW , Komeya AY , et al . Dermatologically challenging syphilis presentation . Int J STD AIDS 2019 ; 30 ( 7 ): 707 - 9 . doi: 10.1177/0956462418817636 https://dx.doi.org/10.1177/0956462418817636 . DOI: 10.1177/0956462418817636 http://doi.org/10.1177/0956462418817636 http://journals.sagepub.com/doi/10.1177/0956462418817636 http://journals.sagepub.com/doi/10.1177/0956462418817636

Mainetti C , Scolari F , Lautenschlager S . The clinical spectrum of syphilitic balanitis of Follmann: report of five cases and a review of the literature . J Eur Acad Dermatol Venereol 2016 ; 30 ( 10 ): 1810 - 3 . doi: 10.1111/jdv.13802 https://dx.doi.org/10.1111/jdv.13802 . DOI: 10.1111/jdv.13802 http://doi.org/10.1111/jdv.13802

Eccleston K , Collins L , Higgins SP . Primary syphilis . Int J STD AIDS 2008 ; 19 ( 3 ): 145 - 51 . doi: 10.1258/ijsa.2007.007258 https://dx.doi.org/10.1258/ijsa.2007.007258 . DOI: 10.1258/ijsa.2007.007258 http://doi.org/10.1258/ijsa.2007.007258

Buffet M , Grange PA , Gerhardt P , et al . Diagnosing treponema pallidum in secondary syphilis by PCR and immunohistochemistry . J Invest Dermatol 2007 ; 127 ( 10 ): 2345 - 50 . doi: 10.1038/sj.jid.5700888 https://dx.doi.org/10.1038/sj.jid.5700888 . DOI: 10.1038/sj.jid.5700888 http://doi.org/10.1038/sj.jid.5700888

Hoang MP , High WA , Molberg KH . Secondary syphilis: a histologic and immunohistochemical evaluation . J Cutan Pathol 2004 ; 31 ( 9 ): 595 - 9 . doi: 10.1111/j.0303-6987.2004.00236.x https://dx.doi.org/10.1111/j.0303-6987.2004.00236.x . DOI: 10.1111/j.0303-6987.2004.00236.x http://doi.org/10.1111/j.0303-6987.2004.00236.x

Engelkens HJ , ten Kate FJ , Judanarso J , et al . The localisation of treponemes and characterisation of the inflammatory infiltrate in skin biopsies from patients with primary or secondary syphilis, or early infectious yaws . Genitourin Med 1993 ; 69 ( 2 ): 102 - 7 . doi: 10.1136/sti.69.2.102 https://dx.doi.org/10.1136/sti.69.2.102 . DOI: 10.1136/sti.69.2.102 http://doi.org/10.1136/sti.69.2.102

浏览量

475

Downloads

CSCD

文章被引用时，请邮件提醒。

Submit

关联资源

Pneumonia, Multiple Pulmonary Infarction and Abscess Caused by a Bamboo Stick Accidentally Piercing into Chest: a Case Misdiagnosed as Pulmonary Tuberculosis