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October 1993

Case of Syphilis with Unusual Features

Arch Dermatol. 1993;129(10):1252. doi:10.1001/archderm.1993.01680310022002

The patient came to the City Hospital about two months ago with what appeared to be a chancroid under the prepuce and a greatly inflamed and enlarged penis. A dorsal incision revealed an ulcer with no marked induration, of phagedenic character and extensive sloughing reaching very far upwards, almost to the symphysis. He was treated locally. After two weeks pustules began to develop on one side of the face and forehead, which gradually extended over the neck, back, chest, and after two weeks reached the lower extremities. A high temperature during the eruption of the pustules and the appearance of the lesions themselves for a few days was so suggestive of variola that the patient was isolated on the recommendation oftheBoardofHealth. The pustules developed later into rather deep ulcérations with considerable sloughing. The eruption at first was so unusual for a first eruption of syphilis, that the diagnosis seemed doubtful for some time.

Dr. Lustgarten had no doubt of syphilis from the present appearance of the case; the precocious malignant eruptions were not of very frequent occurrence. We did not know exactly what caused them; all explanations had been merely hypothetical. The pustular character of the syphilitic eruption suggested the presence of another infection besides that with the syphilitic virus.

Dr. Allen stated that it was only for a few days that he had been in doubt about the diagnosis. There seemed to exist a certain connection between phagedenism and the suddenly appearing pustular process on the skin, which he thought due to some other virus than that of syphilis—to a mixed infection.

J Cutan Genito-Urin Dis.

October 1893;11:409-410.