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April 29, 1961

Primary Cutaneous Diphtheria

Author Affiliations

Fort Lauderdale, Fla.

From the Department of Dermatology, University of Miami School of Medicine.

JAMA. 1961;176(4):273-275. doi:10.1001/jama.1961.03040170019005

Within the United States, where ulceration of the skin is but rarely caused by the Klebs-Löffler bacillus, the diagnosis of primary cutaneous diphtheria may be missed, and serious, even fatal, complications may ensue. The primary lesion, in this case of a 30-year-old man, was a pustule located on the shoulder. It developed into an indolent, intractable ulcer, shielded by an eschar clinically indistinguishable from anthrax. The skin test to diphtheria antitoxin was negative. A negative Schick test has been found not to be a criterion of immunity to cutaneous diphtheria. Intravenous administration of massive doses of penicillin was followed by dramatic recovery from the constitutional symptoms and healing of the lesion.