case_images: PMC5389225_01
case_images: (a) A partially healed, indurated ulcer with a clean base on the prepuce. (b) and (c) The distal palmar surface of fingers showed asymptomatic well-defined, discrete, firm, multiple bilateral grayish-white, oval, and spherical papules
case_images: IJSTD-38-92-g001.jpg
case_images: PMC5389225_01_IJSTD-38-92-g001.jpg
case_images: F1
case_images: On examination, a well-defined, solitary, partially healed, indurated ulcer with a clean base was seen on the prepuce [Figure 1a]. The distal palmar surface of fingers showed multiple asymptomatic bilateral grayish-white well-defined discrete firm, oval, and spherical papules [Figure 1b and c].
case_images: Skin biopsy revealed intimal thickening of dermal blood vessel walls with narrowing of lumen amidst abundant fibrocollagenous tissue in the dermis and a sparse mixed cellular infiltrate of plasma cells and lymphocytes
case_images: IJSTD-38-92-g002.jpg
case_images: PMC5389225_01_IJSTD-38-92-g002.jpg
case_images: F2
case_images: A biopsy specimen from the skin lesions on finger revealed hyperkeratosis and intimal thickening of dermal blood vessel walls with narrowing of lumen amidst abundant fibrocollagenous tissue in the dermis and a sparse mixed cellular infiltrate of plasma cells and lymphocytes [Figure 2].
case_images: Dramatic resolution of finger eruptions after 1 week of penicillin injection
case_images: IJSTD-38-92-g003.jpg
case_images: PMC5389225_01_IJSTD-38-92-g003.jpg
case_images: F3
case_images: The patient was treated with a single shot of intramuscular injection Benzathine penicillin (2.4 megaunits) with rapid resolution of the palmar lesions within a week [Figure 3] and also the penile ulcer healed with scarring completely by 10 days.
case_images: The arrow depicts healed circular asymptomatic vulvar ulcer on left labia majora of patient's wife
case_images: IJSTD-38-92-g004.jpg
case_images: PMC5389225_01_IJSTD-38-92-g004.jpg
case_images: F4
case_images: His wife was also examined, and an asymptomatic vulval ulcer on mucosal aspect of her left labia [Figure 4] with bilateral inguinal nodes was revealed in clinical examination.