The Great Imitator:Atypical Cutaneous Manifestations of Primary Syphilitic Chancre  

万能模仿者:梅毒硬下疳的非典型皮肤表现

作　　者：Huizi Gong Mengyin Wu Jun Li Heyi Zheng 巩慧子;吴梦茵;李军;郑和义(中国医学科学院,北京协和医学院北京协和医院皮肤科)

机构地区：[1]Department of Dermatology and Venereology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China

出　　处：《Chinese Medical Sciences Journal》2021年第4期279-283,共5页中国医学科学杂志（英文版）

基　　金：Supported by Beijing Municipal Science and Technology Commission(Z191100006619011);Capital’s Funds for Health Improvement and Research(2020-2-4016)。

摘　　要：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：primary syphilis CHANCRE MISDIAGNOSIS 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]