Early Syphilis Presenting as Thickened Penile Plaques With an Embedded Recurrent Ulcer (Chancre Redux): A Case Report  

作　　者：Stephen C.Davies Rodney Hannaford Joseph Cotter 

机构地区：[1]Northern Sydney Sexual Health Service,Northern Sydney Local Health District,St Leonards,NSW 2065,Australia [2]Northern Beaches Dermatology,Mona Vale,NSW 2103,Australia

出　　处：《International Journal of Dermatology and Venereology》2024年第3期160-162,共3页国际皮肤性病学杂志（英文）

摘　　要：Introduction:The manifestations of syphilis are varied,and serology can establish the diagnosis early,especially in rare cases.We report a case of chancre redux(a rare recurrence of primary syphilis),which was embedded within a secondary syphilitic penile skin plaque.There were missed opportunities at earlier diagnosis as serology for syphilis was not ordered.Case presentation:A 56-year-old man presented with thickened penile plaques for five months.He reported a small penile ulcer approximately one month prior.There was no history of other skin lesions or rash.However,clinically there was an asymptomatic,indurated ulcer embedded within a plaque which was swab-positive for syphilis by PCR.A punch biopsy of a plaque was spirochaete-positive using an immunoperoxidase stain.The patient’s lesions resolved three weeks after treatment with intramuscular benzathine penicillin.Discussion:Uncommonly reported even in the preantibiotic era,chancre redux is now rare.The ulcer usually recurs at or near the site of the original chancre,and has similar morphological features.The skin lesions of secondary syphilis can exhibit remarkable morphological variety.The most common skin manifestation,a generalized macular rash,was not present at any time in this case.Rather,there were only a couple of nonspecific penile plaques.If biopsy is performed,histologic findings are variable,though typically the inflammatory infiltrate includes plasma cells.A special immunoperoxidase stain can highlight spirochaetes in biopsy sections.Conclusion:This case highlights the importance of considering syphilis in the differential diagnosis of persistent,atypical penile lesions and underscores the need for appropriate serological testing in such instances.

关 键 词：primary syphilis secondary syphilis chancre redux immunohistochemistry IMMUNOPEROXIDASE genital rash 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]