Erythematous Erosive Patch on the Left Nipple—Quiz Case

Primary syphilitic chancre on the upper arm in an HIV-1-infected patient

“…1–3 Extragenital syphilitic chancres may occur at least in 5% of patients with syphilis, 4 usually affecting sexually exposed sites of the human body including the rectum, lips, 5 oral cavity, 6 tongue 7–9 or nipple. 10,11 To our knowledge only three cases of syphilitic chancres have been observed on the arm, 12 hand 13 and finger, 14 respectively. Our case report however is the first to show an extragenital syphilitic chancre on the upper arm in a patient with HIV-1 infection.…”

A solitary erosive patch on the left nipple

“…The entry of Treponema pallidum into the host is promoted by abrasion of the skin. 2 In this case, the patient denied any recent sexual intercourse but acknowledged that the nipple had oral contact four weeks before the lesion appeared. The rest of the mucocutaneous examination revealed no remarkable findings.…”

“…About 5% of chancres are located outside of the genitalia and can develop at any mucocutaneous site exposed to infectious sources. 1,2 The most commonly reported sites include the lips, oral mucosa, and anus. The chin, ear, neck, and arms are less common sites.…”

“…The differential diagnosis includes eczema of the nipple, erosive adenomatosis of the nipple, or mammary Paget disease. [2][3][4] Eczema of the nipple is more commonly observed in women with severe pruritus and involves the nipples bilaterally. Generally, eczematous lesions of the nipple are not suggestive of an extragenital syphilitic chancre.…”

“…Pain and itching are frequently reported. 2 However, serology tests and skin biopsy of the chancre are helpful for the diagnosis of syphilis. The diagnosis is also supported by dark-field microscopic examination, 2 and taking a thorough history can be the important diagnostic clue.…”