Korean J Infect Dis.  2000 Apr;32(2):164-166.

Extragenital Primary Syphilis Acquired by Scratching with the Fingernails

Affiliations
  • 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
  • 2Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.

Abstract

A 46-year-old woman was admitted with an ulcerative lesion on the posterior neck. Four months before admission, the patient took part in a faith healing ritual, which the pastor performed with his fingernails causing wounds. This abnormal method of healing caused repeated injury to the patient in the posterior neck area. Treatment with cefazolin was begun, but the lesion did not improve. Biopsy of the skin lesion and cervical lymph nodes was performed. Microscopical examination revealed findings highly suggestive of syphilis. Serological tests for syphilis were positive and a computed tomographic (CT) scan of the neck showed enlargement of regional lymph nodes and tonsils. A single dose of penicillin G 2.4 million units was given intramuscularly. Two weeks later, the wound had healed. Eight weeks after treatment, the Venereal Disease Research Laboratory titer had decreased and a CT scan of the neck showed a decrease in the size of the lymph nodes. We reasoned that syphilis was non-sexually transmitted, and that the healing ritual was the cause. Our case suggests that skin trauma by scratching with the fingernails may cause an accidental direct inoculation of Treponema pallidum, resulting in extragenital primary syphilis.

Keyword

Syphilis; Skin; Scratching

MeSH Terms

Biopsy
Cefazolin
Faith Healing
Female
Humans
Lymph Nodes
Middle Aged
Nails*
Neck
Palatine Tonsil
Penicillin G
Serologic Tests
Sexually Transmitted Diseases
Skin
Syphilis*
Tomography, X-Ray Computed
Treponema pallidum
Ulcer
Wounds and Injuries
Cefazolin
Penicillin G
Full Text Links
  • KJID
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
    DB Error: unknown error