Secondary syphilis with acute mastitis as the initial manifestation

A 30-year-old woman presented to the Dermatology Department with a 1-week history of painless breast ulcer. A magnetic resonance imaging (MRI) conducted at the Breast Surgery Department before presentation suggested a suspicion of acute mastitis. She reported that her partner had kissed her breast 2 months ago. Physical examination revealed diffuse erythema and ulceration on the right breast, with surface crusting and desquamation noted (Figure 1a), and non-confluent maculopapules across the body. Laboratory tests revealed positive results for TPPA and RPR (Titre, 1:512). Histopathological examination of the breast lesion biopsy demonstrated interfacial dermatitis characterized by infiltration of plasma cells, lymphocytes and histiocytes. Immunohistochemical staining for Treponema pallidum was also positive (Figure 1b). A diagnosis of secondary syphilis was made. Given the patient's penicillin allergy, she was treated with daily oral doxycycline for 1 month. At the 5-month follow-up visit, the rash had completely resolved and the RPR titre was 1:4. None. All authors have no conflicts of interest to declare. The study was reviewed and approved by an institutional review board or ethics committee at participating centres. The study was conducted in accordance with the Declaration of Helsinki and adhered to Good Clinical Practice guidelines. The patient in this manuscript has given written informed consent to the publication of her case details. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.