Solitary syphilitic chancre on the neck: LANCET case report
A 47-year-old woman presented with a 1-month history of a painful, itching, non-healing, and oozing lesion on the left side of her neck. In addition to the lesion, she reported having disturbed sleep because of pain and pruritus in the affected area. The problem developed between 4 and 5 weeks after a trip to the Mediterranean coast of southern Turkey. An oral antibiotic and iodine ointment had failed to make any improvement.

On clinical examination, the lesion was a single ulcer with yellow exudate and an indurated erythematous margin. The patient also had palpable, indolent lymphadenopathy of the submental lymph nodes. A bacterial swab revealed coagulase-negative staphylococci. Initially, we suspected that the patient might have cutaneous leishmaniasis and we took two punch biopsy samples from both the centre and margin of the lesion for PCR and histological analyses.

Haematoxylin and eosin staining of the central biopsy showed plasma-cell-rich granulation tissue. Immunohistochemical staining for Treponema pallidum showed spirochetes. Laboratory test results demonstrated a positive non-treponemal venereal disease research laboratory test titre of 1:8, as well as positive specific assays—the T pallidum particle agglutination assay, IgM immunoblot, and IgG ELISA.

On further inquiry, the patient explained that she had unprotected sexual intercourse during her holiday. She reported that her partner had wounds on the lips that may have been the source of infection. A diagnosis of a primary syphilitic chancre was made, and the patient was treated with benzylpenicillin at 2 400 000 IU, intramuscularly. The ulceration resolved 3 weeks after treatment.

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