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August 1991

Syphilis of Abnormal Evolution

Arch Dermatol. 1991;127(8):1156. doi:10.1001/archderm.1991.01680070056005

(Annales de Dermal, et de Syph., May 25th, 1891.)

A case of syphilis was presented before the society with a history of having entered the hospital on account of a vaginitis and ulcerations of the vulva and anus having all the characteristics of simple chancres in course of healing. Shortly after the patient was taken down with typhoid fever and when convalescent contracted scabies. Frictions of styrax ointment were made and within a few days pustules of ecthyma formed on the arms and were soon succeeded by ulcérations which were absolutely chancrelike, having a deep red color, indurated base, etc. There were two on the left arm and four on the right. A few days later there was painful lymphangitis and slight swelling of the axillary glands. Three weeks later there was decided headache and in eight days more a well-marked roseola. The question is whether the syphilis was contracted before entering the hospital and the retarded evolution was due to the typhoid fever, or were the lesions on the arms multiple chancres contracted in the hospital?

Dr. Vidal thought the lesions had been those of chancrelike ecthyma, such as has been called syphilitic ecthyma.

Dr. Fournier had believed them to be syphilitic chancres and regarded the subsequent evolution of the disease with the roseola appearing a month later as confirmatory of this diagnosis. A similar case had occurred in his service at the St. Louis where a patient, who had entered for an eczema consecutive to a treatment for scabies, contracted syphilitic chancres of the forearm.

Dr. Besnier thought the lesions those of secondary syphilis, which had been modified by the itch.

Dr. Fournier pointed out that this would make the appearance of the roseola subsequent to the cutaneous plaques, which is rare. [Though the question is left unsettled, it has its points of interest. What will strike the average reader is the peculiar danger from hospitalism in the French capital, when a girl who enters with a simple vaginitis has her stay prolonged by contracting typhoid fever, the itch, and possibly syphilis.]

Charles W. Allen.

J Cutan Genito-Urin Dis.

August 1891;9:314-315.

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