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A Case of Syphilitic Rupia.

K. C. YEO, M.B., B.S.

S.Y., Male, Chinese, aet. 40 years, printer, was admitted to the University Medical Clinic on the 9th. of May, 1926, for cutaneous eruption of head, face, trunk, upper and lower limbs of 35 days' duration.

Personal History:

He was married at 19 years of age. His wife who died 6 years later as a result of child birth, had two abortions and gave birth to three children, all of whom died between the ages of 2 and 8.

History of Past Illness:

He contracted gonorrhoea 21 years ago. 2 years ago, he had occasional attacks of malaria. History of Present Illness:

Two months ago, patient contracted gonorrhoea and syphilis, the symptoms of the former being described by him as a "burning sensation during micturition and a urethral discharge which stained the linen." Eighteen days after exposure, a phagedenic type ulcer developed near the corona of the glans penis, accompanied by large buboes. He was treated by a friend, who was working in a local dispensary, and he said that his condition was "cured" after 16 days' treatment. Two months after exposure, dusky erythematous papulae, each about the size of a pea, appeared. Synchronous with the appearance of the eruption, his voice became hoarse. The eruption then spread down to the face, neck, trunk, upper and lower limbs, taking five days to become generalised. A week later, pustules were formed and on the day of admission, a rupioid eruption was observed all over the body.

Condition on Admission:

General Condition: Except for the generalised eruption, giving the patient a hideous appearance and pointing to some circulatory disturbance, there was nothing of note in the other systems. The Wassermann was strongly positive. There was no eruption on any mucous surface.

The Eruption: (see accompanying photographs). The individual pustule was covered with a dark-brownish-red scab, under which, owing to the peripheral extension of ulceration, successive layers of crust were formed, each wider than its predecessor until there was produced a somewhat conical, laminated, blackish crust, liken an oyster-shell.

Treatment:

Locally, Ungt. Calomel. was applied. A course of "914" was given starting with .3 gram. Patient reacted to the injections very well, having a slight rise of temperature and headache after every injection. Mercury and Potassium Iodide were given internally at the same time.

Condition on Discharge (see photographs):

The crusts had disappeared and the ulcers appeared as pinkish spots with pigmented borders.

Remarks:

(1) The pustular syphilides of the rupial type are usually a comparatively late manifestation, occurring six to twelve months after the chancre or even later. In the present case, the cutaneous manifestation occurred only two months after the chancre. The explanation is that it might be a particularly virulent form, or that the patient contracted syphilis earlier than the date given by him, as evidenced by the abortions his wife had and the early death of his children.

(2) Syphilitic rupia occurs most frequently in individuals debilitated by illness and is especially liable to follow a virulent chancre, which has become phagedenic, as in this case.

I am indebted to Prof. J. Anderson for his kind permission to record this case.