Objective To analyze the reasons of misdiagnosis of primary syphilitic chancre and strengthen the understanding of atypical features of this disease. Methods A case series of twenty-seven challenging primary syphilis patients who were not immediately recognized as chancre was included in our study. The clinical data including the patients' age, sex, skin lesions, HIV status, syphilis serologic test results, treatment, and follow-up results were collected. Hematoxylin-eosin and immunohistochemistry staining of skin biopsy sections were reviewed. Results Four female cases with extragenital chancres presenting as erythema or erosive skin lesions on the nipple were misdiagnosed as Paget's disease or eczema. The disorder of missed or misdiagnosed male cases manifested as syphilitic balanitis or multiple chancres on the penis root and adjacent pubis rather than coronal sulcus or frenum. Patients with nonreactive nontreponemal tests at initial presentation were also easily missed or misdiagnosed. Conclusion Primary syphilis presenting as multiple lesions rather than a single chancre, at atypical locations, or with a nonreactive nontreponemal test result, tends to be missed or misdiagnosed.
Chancre/diagnosis* ; Female ; Humans ; Male ; Nipples ; Skin ; Syphilis/diagnosis*

Using the FTA-ABS complernent test, 32 skin speciruens from 27 patients with primary and secondary syphilis and a stomach specimen from a patient with suspected gastric syphilis which were confirmed by clinical history, physical examination, VDRL, FTA-ABS, and 19S(IgM)-FTA test, were tested. The following results were obtained. 1. In the darkfield examination, 7 of the 9 specimens(78%) were positive and in the FTA-ABS complernent test, 20 of the 33 specimens(61%) were positive. 2. The ratio of agreement between the darkfield examination and the FTA-ABS complement test was 89%. 3. In the chancres, macular syphilids, and condyloma lata, T. pallida were diffusely scattered in the epidermis, dermoepidermal junction, connective tiasue, and vascular walls, whereas in the papular syphilid T. pallida were mainly aggregated in the the epidermis, dermoepidermal junction, papillary dermis as well as the blood vessel walls in the papillary dermis. From these results, the FTA-ABS complement test can be considered to be a useful method for both the diagnosis and research of syphilis. It is especially helpful in cases where serological or histopathological study can not confirrn the diagnosis as when internal organs are involved.
Blood Vessels ; Chancre ; Complement System Proteins* ; Dermis ; Diagnosis ; Epidermis ; Humans ; Physical Examination ; Skin ; Stomach ; Syphilis ; Syphilis, Cutaneous ; Treponema pallidum* ; Treponema*

Clinical, mycoIogical, histopathological and epidemiological studies were done on 26 cases of cutaneous sporotrichosis which were found during the last 5 years, from 1967 to 1971, at the out-patient clinic of department of dermatology of this hospital, and the results obtained were as follows: 1. Twenty two cases of ascending lympho-cutaneous sporotrichosis with nodules, abscesses and chancres, 2 cases of gummatous, and one of each verrucoid and impctiginous types were found in total 26 cases of the disease. 2. All the patients encountered were inhabitants in rural area, and most of them were farmers (21 cases: 81%)and children living in that area. The sources of the infection were considered as soil and plants contaminated with the causative organism. 3. Age distribution of the disease revealed highest incidence in the fourth and fifth decades (l8 cases: 69%), who were active workers in Korean farm.4. Analysis of primary focus and affected region of the body revealed highest involvement over the upper extremities (19 cases: 73%), especially right hand (9 cases: 35%) and right arm (3 cases: 12%). 5. Better culture results were obtained as following order: the best with culture material aspirated from the closed abscess with sterile needIe and syringe, the second: with embeding the tissue from the lesion in the media exposing about half, and the third: with the materials obtained from the chancre and gumrnatous lesiors. 6. Histopathological findings revealed frequently the chronic inflammatory granulomatous tissue reaction with polymorphic cellularity and occasionally some vascularity or small multiple focal necrosis in the lesions. 7. Differential diagnosis of the disease should be considered with Lepromatous leprosy, Cysticercosis cutis, Tuberculosis of the skin and other mycobacteriosis of the skin particularly in this country. 8. In Korea the rate of the incidences of the disease was found to be the highest in Chonnam province by comparing the result obtained from this study with those of the report by others. In Chonnam province the disease were distributed almost all the counties but there were some different rates of the incidence of the disease between each counties. 9. Frequency of the disease among the total number of out-patients (12. 208) was 0.2% or 1 to 500 and showed relatively high incidence of the disease in the farm workers in Chonnam province, Korea. Clinical, mycoIogical, histopathological and epidemiological studies were done on 26 cases of cutaneous sporotrichosis which were found during the last 5 years, from 1967 to 1971, at the out-patient clinic of department of dermatology of this hospital, and the results obtained were as follows: 1. Twenty two cases of ascending lympho-cutaneous sporotrichosis with nodules, abscesses and chancres, 2 cases of gummatous, and one of each verrucoid and impctiginous types were found in total 26 cases of the disease. 2. All the patients encountered were inhabitants in rural area, and most of them were farmers (21 cases: 81%)and children living in that area. The sources of the infection were considered as soil and plants contaminated with the causative organism. 3. Age distribution of the disease revealed highest incidence in the fourth and fifth decades (l8 cases: 69%), who were active workers in Korean farm.4. Analysis of primary focus and affected region of the body revealed highest involvement over the upper extremities (19 cases: 73%), especially right hand (9 cases: 35%) and right arm (3 cases: 12%). 5. Better culture results were obtained as following order: the best with culture material aspirated from the closed abscess with sterile needIe and syringe, the second: with embeding the tissue from the lesion in the media exposing about half, and the third: with the materials obtained from the chancre and gumrnatous lesiors. 6. Histopathological findings revealed frequently the chronic inflammatory granulomatous tissue reaction with polymorphic cellularity and occasionally some vascularity or small multiple focal necrosis in the lesions. 7. Differential diagnosis of the disease should be considered with Lepromatous leprosy, Cysticercosis cutis, Tuberculosis of the skin and other mycobacteriosis of the skin particularly in this country. 8. In Korea the rate of the incidences of the disease was found to be the highest in Chonnam province by comparing the result obtained from this study with those of the report by others. In Chonnam province the disease were distributed almost all the counties but there were some different rates of the incidence of the disease between each counties. 9. Frequency of the disease among the total number of out-patients (12. 208) was 0.2% or 1 to 500 and showed relatively high incidence of the disease in the farm workers in Chonnam province, Korea.
Abscess ; Age Distribution ; Arm ; Chancre ; Child ; Cysticercosis ; Dermatology ; Diagnosis, Differential ; Epidemiologic Studies* ; Fisheries* ; Hand ; Humans ; Incidence ; Jeollanam-do ; Korea* ; Leprosy, Lepromatous ; Necrosis ; Outpatients ; Skin ; Soil ; Sporotrichosis* ; Syringes ; Tuberculosis ; Upper Extremity

The high signal intensities in bilateral mesiotemporal lobes on T2-weighted images are typical findings of herpes encephalitis or paraneoplastic limbic encephalitis. We report a case of neurosyphilis with mesiotemporal involvement on MRI. Positive antibodies in the cerebrospinal fluid confirmed the diagnosis. The results suggest that neurosyphilis should be considered when MRI results indicate mesiotemporal abnormalities.
Adult ; Anti-Bacterial Agents/administration & dosage ; Biopsy, Needle ; Chancre/diagnosis/pathology ; Diagnosis, Differential ; Encephalitis, Herpes Simplex/diagnosis ; Follow-Up Studies ; Humans ; Limbic Encephalitis/diagnosis ; Magnetic Resonance Imaging/*methods ; Male ; Neurosyphilis/*diagnosis/drug therapy/pathology ; Penicillins/administration & dosage ; Rare Diseases ; Temporal Lobe/*pathology ; Tongue/pathology