Chancre-like ecthyma

Age: 25 years
Gender: Male
Site: Glans penis distal to the coronal sulcus
Duration: 6 weeks
History: An asymptomatic ulcer started as a painless papule that eroded into an ulcer within few days and increased in size gradually.
Findings:
* Well-defined rounded ulcer with an elevated punched-out border and clean granular base.
* Firm-hard on palpation.
* No regional lymphadenopathy.
Investigations:
VDRL: Negative (repeated twice)
TPHA: Negative (repeated twice)
Gram smear: yielded G-positive cocci
Culture: Mixed Staphylococcus aureus and Strepotococcus pyogenes
Treatment:
Benzathin penicillin 2.4 mega units i.m once every week for 3 weeks with no response (Given by another dermatologist on assumed diagnosis of primary syphilis)!!!
After investigations, it is diagnosed as ECTHYMA and treated with Ciprofloxacillin tablet 500 mg b.i.d plus topical fucidic acid cream twice daily for 10 days with an excellent response!