Syphilitic paronychia: a diagnostic challenge

A 28-year- old HIV-negative male patient presented with a 2-month history of painful inflamed nodules on the tip of his left index and right third finger (figure 1). A biopsy showed an inflammatory infiltrate with plasma cells; immunohistochemistry revealed abundant spirochetes in a mixed perivascular and intercellular pattern (figure 1). Rapid plasma reagin (1:256) and fluorescent treponemal antibody absorption were positive. A diagnosis of primary syphilis with persistent primary chancres was made. Involvement of the fingers has been reported in all syphilis stages but is rare; both the nail plate and periungual tissues can be involved.1 Primary syphilis of the fingers often manifests as ulcerative paronychia, although multiple or bipolar chancres can also be observed.2 Other clinical manifestations include deep painful horseshoe-shaped panaritium, syphilitic dactylitis and diffuse periungual sclerosis.3 The diagnosis of syphilitic paronychia can be challenging, requiring a...
Source: Sexually Transmitted Infections - Category: Sexual Medicine Authors: Tags: Research letter Source Type: research