A Case of Secondary Syphilis with the Extragenital Chancre on the Nipple

Abstract

Syphilis is a sexually transmitted disease caused by Treponema pallidum. The signs and symptoms of syphilis vary depending on which of the four stages it presents. The primary stage of syphilis classically presents with a painless ulcer (chancre). We report a case of the extragenital chancre on the nipple which is examined from skin biopsy and immunohistochemistry. This case showed that it is important to identify the special site’s pruritus erythema by pathology and serological examination.

A crusted ulcer of the nipple

“…One patient presented with bilateral involvement 5 . Five cases developed a secondary syphilis rash during the follow‐up 3,5,7,12,15 …”

“…2 To the best of our knowledge, extragenital syphilitic chancres on nipple region have been described in 16 patients (3 females, 13 males) (Table 1). [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Bites, nibbles or trauma on the nipple during sexual intercourse were reported in ten patients, [3][4][5][6]9,[11][12][13]15 whilst one patient had had genital-nipple contact 8 and another both nipple bite and nipple-genital contact. 17 Lesions were variably described as erosions, ulcers, and crusted plaques.…”

“…5 Five cases developed a secondary syphilis rash during the followup. 3,5,7,12,15 A solitary eroded lesion on the nipple can present diagnostic challenges to both clinicians and pathologists. If the patient fails to disclose his sexual behavior, an unusual presentation of syphilis could be mistaken for other diseases.…”

An ulcerative lip lesion

“…This is a syphilitic chancre of the lip, an early manifestation of syphilis that is highly infectious and can be transmitted following unprotected oral sex 1. Although more than 90% of syphilitic chancres appear in genital areas, extragenital chancres can be found on the mouth, chin, finger, nipple, and intrarectal and perianal areas 2345. Syphilitic chancres are commonly painless, but approximately 36% of patients experience some degree of tenderness 6.…”

Ein verkrustetes Ulkus an der Brustwarze

“…Ein Patient war beidseitig betroffen 5 . In fünf Fällen entwickelte sich während der Nachbeobachtungszeit ein sekundärer Syphilisausschlag 3,5,7,12,15 …”