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Khan M, Sharma A, Hathorn T, Sandhu M, Rosen R, Riddle N, Mifsud M. The Mucosal Manifestations of Syphilis in the Head and Neck. EAR, NOSE & THROAT JOURNAL 2023:1455613231165159. [PMID: 37129418 DOI: 10.1177/01455613231165159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Objectives: Syphilis is a resurging disease which can present itself in many ways, including lesions within the head and neck mucosa. Some of these lesions may clinically mimic oral malignancies. This literature review aims to better characterize the mucosal presentations of syphilis. Methods: PubMed, EMBASE, and clinicaltrials.gov were searched for full-text, English articles published from 1950 to 2022 that reported patients with head and neck mucosal manifestations of syphilis. Articles were screened according to PRISMA guidelines. Results: One hundred forty-three manuscripts documenting 236 individual patients were included in the review. Patients with secondary syphilis accounted for 62% of patients presenting with head and neck mucosal lesions. The most common lesions found in primary and secondary syphilis were ulcerations, primarily found on the tongue, lips, and palate. While serologic studies are the gold standard for diagnosing syphilis, biopsy of these lesions have characteristic syphilitic changes. Conclusions: Syphilis' nickname of "The great imitator" remains to be true, and the head and neck mucosal manifestations of this disease can resemble commonly seen malignancies. Awareness of this disease and its lesions is prudent given the rising incidence of syphilis within the United States.
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Affiliation(s)
- Mahnoor Khan
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Abhay Sharma
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Travis Hathorn
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Mannat Sandhu
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Ross Rosen
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Nicole Riddle
- Department of Pathology and Cell Biology, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Matthew Mifsud
- Department of Otolaryngology - Head and Neck Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
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2
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Ramírez-Amador V, Castillejos-García I, Maldonado-Mendoza J, Saeb-Lima M, Aguilar-León D, Anaya-Saavedra G. Exposing the Great Imitator: Proposal for a Holistic Diagnosis of Oral Secondary Syphilis in People Living with HIV. Head Neck Pathol 2022; 16:773-784. [PMID: 35334094 PMCID: PMC9424447 DOI: 10.1007/s12105-022-01446-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/05/2022] [Indexed: 10/18/2022]
Abstract
Oral secondary syphilis may mimic various infectious, neoplastic, or immune-mediated processes; hence, its diagnosis may represent a challenge. Early diagnosis of syphilis, a disease that has increased in recent decades, is essential for adequate management, particularly in people living with HIV (PLWH). This study aimed to comprehensively characterize oral secondary syphilis in a group of 47 PLWH. A group of PLWH with oral secondary syphilis attending four HIV-referral centers in Mexico City was included (2004-2021). Clinical and laboratory data were retrieved, and an exhaustive oral examination was performed following the established criteria. Demographic, clinicopathological, immunohistochemical, and serological features of the patients were analyzed. Approximately 11% of PLWH with oral secondary syphilis demonstrated negative Venereal Disease Research Laboratory tests. A noticeable feature was the absence of symptoms in 95.7% of cases, despite the clinically evident appearance of the lesions. In contrast to previous results, 18% of ulcerations were detected to be deep, crateriform, and infiltrative, and 22% of the mucous patches were highly keratotic lesions. Most samples (77.3%) showed superficial lymphoplasmacytic infiltrates in the superficial lamina propria, with perivascular and perineural patterns, and immunohistochemistry was positive in 66.7% of the cases. The "great imitator" appears not only clinically but also histopathologically and immunohistochemically, where features may be comparable with those of chronic inflammatory processes, deep infections, or malignant processes. Although not recommended as a routine assay, IHC could be a critical tool, particularly in PLWH with atypical clinical features or with negative and/or dubious serology.
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Affiliation(s)
- Velia Ramírez-Amador
- Oral Pathology and Medicine Master, Health Care Department, Autonomous Metropolitan University, Calzada del Hueso 1100, col. Villa Quietud, 04960, Mexico City, Mexico
| | - Itzel Castillejos-García
- Oral Pathology and Medicine Master, Health Care Department, Autonomous Metropolitan University, Calzada del Hueso 1100, col. Villa Quietud, 04960, Mexico City, Mexico
| | - Jessica Maldonado-Mendoza
- Oral Pathology and Medicine Master, Health Care Department, Autonomous Metropolitan University, Calzada del Hueso 1100, col. Villa Quietud, 04960, Mexico City, Mexico
| | - Marcela Saeb-Lima
- Pathology Department, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Diana Aguilar-León
- Pathology Department, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Gabriela Anaya-Saavedra
- Oral Pathology and Medicine Master, Health Care Department, Autonomous Metropolitan University, Calzada del Hueso 1100, col. Villa Quietud, 04960, Mexico City, Mexico.
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3
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Hill B, Mugayar LRF, da Fonseca MA. Oral Health Implications of Risky Behaviors in Adolescence. Dent Clin North Am 2021; 65:669-687. [PMID: 34503660 DOI: 10.1016/j.cden.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adolescence is a time for new discoveries, which may lead teens to engage in impulsive behaviors. Although social media and the Internet have brought great benefits to the world, they can also have a negative influence on adolescents, facilitating their engagement in risky behaviors. Positive parenting and healthy friendships in adolescence have a protective effect against sensation-seeking behaviors. Dental practitioners also have a significant role in steering young patients toward healthy behaviors. They play an essential role in the early recognition, initiation of appropriate interventions, and referrals for treatment of youth at risk.
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Affiliation(s)
- Brittaney Hill
- Department of Pediatric Dentistry, College of Dentistry, University of Illinois Chicago, 801 South Paulina Street, Suite 250 (MC-850), Chicago, IL 60612, USA
| | - Leda R F Mugayar
- Department of Pediatric Dentistry, College of Dentistry, University of Illinois Chicago, 801 South Paulina Street, Suite 250 (MC-850), Chicago, IL 60612, USA
| | - Marcio A da Fonseca
- Department of Pediatric Dentistry, College of Dentistry, University of Illinois Chicago, 801 South Paulina Street, Suite 250 (MC-850), Chicago, IL 60612, USA.
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Smith MH, Vargo RJ, Bilodeau EA, Anderson KM, Trzcinska A, Canterbury CR, Fantasia JE, Rawal YB. Oral Manifestations of Syphilis: a Review of the Clinical and Histopathologic Characteristics of a Reemerging Entity with Report of 19 New Cases. Head Neck Pathol 2021; 15:787-795. [PMID: 33459991 PMCID: PMC8384985 DOI: 10.1007/s12105-020-01283-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Syphilis is a sexually-transmitted infectious disease caused by Treponema pallidum. Cases of primary and secondary syphilis are on the rise in the United States, with a 14.4% increase in new cases noted from 2017 to 2018 and an escalation of 71% between the years 2014 and 2018. Fulfilling its nickname of "the great imitator," oral manifestations of syphilis may mimic a variety of infectious, neoplastic, or immune-mediated processes, both clinically and histopathologically. This large spectrum of appearances can create a diagnostic challenge to the clinician and/or pathologist, leading to delay in diagnosis or misdiagnosis. METHODS A database of oral syphilis cases was created from archives at the University of Kentucky, University of Pittsburgh, LIJMC, Columbia University MC, and University of Tennessee. The age, sex, race, location, duration, and clinical description were recorded. Cases without positive reaction upon immunohistochemistry or serologic tests were excluded. RESULTS We identified 19 new cases of oral syphilis (17 males, one female, and one case unknown sex) and described the clinical and histopathological features of this re-emerging and potentially fatal disease. All cases demonstrated dense lymphoplasmacytic inflammation, often with inflammatory exocytosis or ulceration at the surface, and perivascular inflammation. CONCLUSIONS Early recognition of the histopathologic and clinical manifestations of oral syphilis is imperative for prompt diagnosis, improved patient outcomes, and disease prevention.
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Affiliation(s)
- Molly Housley Smith
- Division of Oral and Maxillofacial Pathology, University of Kentucky College of Dentistry, 800 Rose Street, Rm. 530, Lexington, KY, 40536, USA.
| | - Richard J Vargo
- Oral and Maxillofacial Pathology Specialty Care Unit, A.T. Still University-Missouri School of Dentistry & Oral Health, St. Louis, MO, USA
| | - Elizabeth Ann Bilodeau
- Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, G-135 Salk Hall, 3501 Terrace St., Pittsburgh, PA, USA
| | - K Mark Anderson
- Department of Diagnostic Sciences, The University of Tennessee College of Dentistry, Memphis, TN, USA
| | - Anna Trzcinska
- Head and Neck Pathology Fellow, Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Carleigh R Canterbury
- Division of Oral and Maxillofacial Pathology, Columbia University Medical Center, New York, NY, USA
| | - John E Fantasia
- Department of Dental Medicine, Division of Oral and Maxillofacial Pathology, Long Island Jewish Medical Center, Zucker School of Medicine At Hofstra Northwell Health, New Hyde Park, NY, USA
| | - Yeshwant B Rawal
- Department of Surgical Sciences, Marquette University School of Dentistry, Milwaukee, WI, USA
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5
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Ramírez-Amador V, Anaya-Saavedra G, Calva-Mercado JJ. The challenging diagnosis of overlapping oral primary/secondary syphilis with nonreactive serology. J Cutan Pathol 2020; 47:1058-1062. [PMID: 32666536 DOI: 10.1111/cup.13811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/02/2020] [Accepted: 07/08/2020] [Indexed: 11/28/2022]
Abstract
The prevalence of oral syphilis, known as "the great imitator" because of its diagnostic complexity and varied clinical manifestations, is increasing worldwide, particularly in people living with HIV (PLWH), who could present false-negative serological results. Although some studies have described the variable presentation of oral syphilis in the context of HIV infection, the difficulty in distinguishing between the primary and secondary stages, clinically and histopathologically, underscores the need to describe atypical cases. We report the case of a 28-year-old HIV-positive man presenting with a 3-month history of painless white/red ulcerated lesion on the soft palate. Physical examination revealed an ulcerated lesion with local signs of inflammation. Initial biopsy revealed a nonspecific inflammatory process and immunohistochemistry (IHC) using anti-Treponema pallidum antibodies showed negative results. The results of serological tests for syphilis (Venereal Disease Research Laboratory and fluorescent treponemal antibody-absorption test) were negative on repeated occasions. Nonetheless, polymerase chain reaction (PCR) assay and subsequent IHC for T. pallidum showed positive results, confirming the diagnosis of oral syphilis. This case illustrates that the diagnosis of oral syphilis is challenging in the absence of serological evidence, and specific tests such as PCR and IHC are useful complementary diagnostic tools.
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Affiliation(s)
- Velia Ramírez-Amador
- Oral Pathology and Medicine Postgraduate Program, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, Mexico
| | - Gabriela Anaya-Saavedra
- Oral Pathology and Medicine Postgraduate Program, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, Mexico
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6
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Batista MIHDM, Paulino MR, Castro KS, Gueiros LAM, Leão JC, Carvalho AAT. High prevalence of syphilis in a female prison unit in Northeastern Brazil. EINSTEIN-SAO PAULO 2020; 18:eAO4978. [PMID: 32428062 PMCID: PMC7206982 DOI: 10.31744/einstein_journal/2020ao4978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 08/16/2019] [Indexed: 11/10/2022] Open
Abstract
Objective To determine the prevalence of syphilis and the associated risk factors in a female prison unit. Methods This was a cross-sectional study including 113 women whom data were collected in two stages: first, blood test to check for syphilis seropositivity; and then collection of information through a form to assess risk situations for sexually transmitted infections. Results Overall, syphilis prevalence was found to be 22.1% among the female prison population (n=25) and 28.6% among pregnant women. A statistically significant relationship was found between syphilis infection and previous history of sexually transmitted infections (p=0.04). However, most participants diagnosed with the disease were unaware of a history of sexually transmitted infection in the last 12 months (n=20/80.0%). The use of condom with fixed partners was considered to be a protective factor (odds ratio of 0.76; 95% of confidence interval 0.68-0.85). Conclusion The prevalence of syphilis among the female prison population was high, particularly among pregnant women. Preventive and therapeutic measures as well as appropriate prenatal care can minimize the impact of syphilis in prison systems and, consequently, improve such health outcomes nationwide.
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7
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Atypical ulceration of the hard palate. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:347-352. [PMID: 31270011 DOI: 10.1016/j.oooo.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/04/2019] [Accepted: 01/07/2019] [Indexed: 11/22/2022]
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Cardieri Romeiro PH, Porto HLS, Dos Reis RB. Sífilis: a grande imitadora. HU REVISTA 2019. [DOI: 10.34019/1982-8047.2018.v44.25832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A Sífilis é uma doença de transmissão vertical ou sexual causada por uma bactéria espiroqueta anaeróbia restrita que parasita exclusivamente o homem. Esse termo foi usado pela primeira vez em 1530 mas só em 1905 foi associado ao Treponema. Desde o advento da penicilina, os casos de sífilis decresceram até que há cerca de 20 anos a incidência dessa doença voltou a aumentar. Apesar de ser uma doença com múltiplas manifestações sendo capaz de mimetizar outras comorbidades o diagnóstico e tratamento do Lues é relativamente simples e barato o que vai de encontro a elevada prevalência dessa doença até os dias de hoje. Devido às mudanças epidemiológicas caracterizadas por aumento na incidência e prevalência na última década, o objetivo desta revisão foi apresentar os aspectos relevantes para detecção da doença e aspectos do seu tratamento, levando em conta as diferentes faces da doença, prevenção e tratamento.
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9
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Abstract
Syphilis, a sexually transmitted infection caused by the Gram-negative bacterium Treponema pallidum, is increasing in prevalence in the United States. It has been our experience that primary and secondary syphilis of the aerodigestive tract can afflict a large age spectrum with varied clinical and histopathologic findings, which can lead to diagnostic problems and frequent misdiagnosis. In this study, we describe the histopathologic patterns of syphilis of the aerodigestive tract to expand awareness of its varied appearance. We identify 3 patterns of inflammatory response to syphilis: plasma cell-rich, lymphohistiocytic, and lymphoma-like. We also report the presence of immunoglobulin G4-predominant plasma cells in the inflammatory response as a potential mimicker of immunoglobulin G4-related disease. Lastly, we found that use of T. pallidum immunohistochemical stain is more reliable than Steiner silver stain at the identification of spirochetes. Our study highlights that despite convention, plasma cells are not always abundant in syphilis. Awareness of the histopathologic range of syphilis in the aerodigestive tract by the surgical pathologist can lead to the correct diagnosis and guide appropriate treatment.
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10
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Moscovici L, Lorenzato RZ, Bellissimo-Rodrigues WT, Bellissimo-Rodrigues F. Secondary syphilis: a woman with flat condyloma. Rev Soc Bras Med Trop 2019; 52:e20180295. [DOI: 10.1590/0037-8682-0295-2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/28/2019] [Indexed: 11/22/2022] Open
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11
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Garbin CAS, Pacheco Filho AC, Garbin AJI, Pacheco KTDS. The dentist’s role in syphilis prevention and control. Rev Soc Bras Med Trop 2019; 52:e20180252. [DOI: 10.1590/0037-8682-0252-2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/12/2018] [Indexed: 11/21/2022] Open
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12
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Schuch LF, da Silva KD, de Arruda JAA, Etges A, Gomes APN, Mesquita RA, Vasconcelos ACU, Tarquinio SBC. Forty cases of acquired oral syphilis and a review of the literature. Int J Oral Maxillofac Surg 2018; 48:635-643. [PMID: 30459066 DOI: 10.1016/j.ijom.2018.10.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 09/20/2018] [Accepted: 10/31/2018] [Indexed: 12/31/2022]
Abstract
The aim of this study was to describe 40 cases of acquired oral syphilis (AOS) and to discuss the distribution of demographic characteristics, clinical features, and differential diagnosis of the disease. A retrospective study was conducted covering a 17-year period at a single institution in southern Brazil. Moreover, a literature review was performed through a search of the PubMed database for articles on AOS published between 1955 and March 2018. Data were analyzed descriptively. The predominant group within the case series was male patients in their twenties. The vast majority of cases (92.5%) were in the secondary stage of the disease. The lips were the most commonly affected site, with greyish-white mucous patches and reddish ulcers. In the literature review, the largest number of reported cases came from North America. Male patients in the third and fourth decades of life were most affected. AOS occurred more commonly as mucous patches and ulcers on the tongue and palate. Similarities regarding the distribution by sex, age, and anatomical location were found in the present study when compared to cases reported elsewhere. Clinicians, oral pathologists, and maxillofacial surgeons should familiarize themselves with the variable spectrum of signs and symptoms of AOS in their clinical practice to improve diagnosis and management.
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Affiliation(s)
- L F Schuch
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - K D da Silva
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - J A A de Arruda
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - A Etges
- Diagnostic Centre for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - A P N Gomes
- Diagnostic Centre for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - R A Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - A C U Vasconcelos
- Diagnostic Centre for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - S B C Tarquinio
- Diagnostic Centre for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil
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13
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de Andrade RS, de Freitas EM, Rocha BA, Gusmão ES, Filho MRM, Júnior HM. Oral findings in secondary syphilis. Med Oral Patol Oral Cir Bucal 2018; 23:e138-e143. [PMID: 29476680 PMCID: PMC5911365 DOI: 10.4317/medoral.22196] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/02/2017] [Indexed: 12/27/2022] Open
Abstract
Background Syphilis is a sexually transmitted disease caused by Treponema pallidum. However, there are of hematogenic and vertical transmission. All health care professionals must be aware of the manifestations of this condition, such as oral lesions. Objectives This study to analyze and compare four clinical cases of syphilis that were diagnosed based on lesions in the oral cavity with published literature. Material and Methods Four patients with a confirmed sorologic and clinical diagnosis of syphilis were examined, confirmated from manifestation of oral lesions together with analysis of serological laboratory tests and histopathological analyses. Results Lesions were found in classic sites such as lips, tongue and skin. However, there were also lesions on the hard palate, and labial commissure, which correspond to less than 5% of the syphilis oral manifestations. Conclusions The practice of unprotected oral sex may result in infection and development of syphilis. The acknowledgment of the oral manifestations of syphilis in all its period of training for health professionals is of basic importance, the association of clinical features, histopathological findings and serological tests are required to complete the diagnosis and correct treatment. Key words:Oral syphilis, treponema infections, secondary syphilis.
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Affiliation(s)
- R-S de Andrade
- Av. Limeira, 901 - Areião, Piracicaba, SP 13414-018 Piracicaba, São Paulo, Brazil,
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14
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Ishibashi M. Syphilis of the pharynx. Int J Dermatol 2017; 57:240-241. [PMID: 29231240 DOI: 10.1111/ijd.13869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 11/30/2022]
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NAVAZO-EGUÍA AI, RIOJA-PEÑARANDA E, ECHEVARRIA-ITURBE C, TERÁN-MUÑOZ D, CORDERO-CIVANTOS C, IBAÑEZ-MUÑOZ C. Manifestaciones orales de la sífilis. Caso clínico. REVISTA ORL 2017. [DOI: 10.14201/orl.16751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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16
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Secondary Syphilis Presenting as Glossodynia, Plaques en Prairie Fauchée, and a Split Papule at the Oral Commissure: Case Report and Review. Case Rep Med 2017; 2017:1980798. [PMID: 28785283 PMCID: PMC5529628 DOI: 10.1155/2017/1980798] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/31/2017] [Indexed: 11/18/2022] Open
Abstract
Syphilis has been coined "the great imitator" due to its extreme heterogeneity of presentation and mimicry of other conditions. Therefore, it is essential that physicians be familiar with the full spectrum of its manifestations. Syphilis may also lead to oral lesions that, occasionally, are unaccompanied by concomitant tegumentary findings. Such patients will pose unique diagnostic challenges. We report the case of a 45-year-old HIV-infected male patient in whom secondary syphilis presented with burning mouth and dysgeusia that progressed to glossodynia and odynophagia. Examination revealed painful, shallow erosions on the posterior aspect of the tongue, in a pattern of plaques en prairie fauchée. A painful split papule (fausse perlèche or false angular cheilitis) was also present in the left commissure. There were no cutaneous lesions. The oral lesions were considered highly suggestive of secondary syphilis. A novel VDRL assay (which was previously negative) yielded a titer of 1/128. Complete clinical remission was rapidly achieved after initiation of penicillin therapy. A comprehensive review of the literature on oral manifestations of syphilis is offered.
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Santosh ABR, Reddy BVR. Oral Mucosal Infections: Insights into Specimen Collection and Medication Management. Dent Clin North Am 2017; 61:283-304. [PMID: 28317567 DOI: 10.1016/j.cden.2016.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Oral mucosal infections appear as localized or generalized lesions. Symptoms range from almost unnoticeable lesions to severe pain. Systemic disease, age, immunocompromised condition, and medication use are common causes. Local causes include dentures, poor oral hygiene, traumatized epithelium, ulcerations, dentures, implants, oral piercing, and reduced salivary secretion. Oral mucosal infections are underdiagnosed and microbiological diagnosis should be more frequently used. Candidiasis is most frequently diagnosed. Clinical appearances are not always clear and are varied, creating a diagnostic challenge. Thorough understanding of clinical appearance and updated information on diagnostic and therapeutic management are essential for successful patient outcome.
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Affiliation(s)
| | - Baddam Venkat Ramana Reddy
- Department of Oral and Maxillofacial Pathology, SIBAR Institute of Dental Sciences, Takkellapadu, Guntur, Andhra Pradesh 522601, India
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