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JAMA Clinical Challenge

A Crusted Plaque on the Right Nipple

Image of A, Crusted plaque on the right nipple with generalized erythematous macular eruption. B, Close-up view of the right nipple

Hsien-Yi Chiu, MD
Tsen-Fang Tsai, MD
A healthy 27-year-old heterosexual man presents with a crusted plaque on his right nipple. The lesion formed gradually over a week after a bite during sexual intercourse and has persisted for a month. The patient reports that over the following 2 to 3 weeks, no significant change in size or morphology of this lesion occurred. The lesion is not painful; neither fever nor associated systemic symptoms are noted. Now, 1 month later, the patient presents with a generalized asymptomatic skin eruption. Physical examination reveals generalized pink macules on the trunk and extremities (Figure, A). A crusted, erythematous plaque is noted over the enlarged right nipple (Figure, B).

See the full article for an explanation and discussion.

Author Affiliations: Drs Tsai (tftsai@yahoo.com) and Chiu are affiliated with the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.