PMC5389225_01
(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
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F1
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].
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
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F2
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].
Dramatic resolution of finger eruptions after 1 week of penicillin injection
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F3
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.
The arrow depicts healed circular asymptomatic vulvar ulcer on left labia majora of patient's wife
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F4
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.