By vgreene, 3 April, 2018
By vgreene, 3 April, 2018
By vgreene, 3 April, 2018
(BMJ)—A 39-yo woman presented w/ a painless ulcer on her L nipple that had been present for 5wk. She also reported malaise. She denied any recent travel but did recall breast biting and breast-genital contact during sexual intercourse 2wk prior to onset. Exam: demarcated ulcer w/ raised, crusted, indurated border. L axillary lymphadenopathy was present. What is the dx?
Herpes simplex virus infection
Impetigo
Squamous cell carcinoma
Syphilitic chancre
Paget disease of breast
You are correct. Immunohistochemistry revealed Treponema pallidum in the epidermis and superficial dermis. Rapid plasma reagin (RPR) test was reactive at a titer of 1:64, confirming the dx of syphilitic chancre. The pt received 2.4 million units of IM benzathine penicillin G x1 and achieved complete resolution of the ulcer in 2wk. RPR titer decreased 1:2 by 6mo and became negative after 2y.

BMJ 2018;360:j5850