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.
Funt TR. Primary Cutaneous Diphtheria. JAMA. 1961;176(4):273–275. doi:10.1001/jama.1961.03040170019005
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