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Meena A, Hanumanthu V, Tekchandani U, Bansal R, De D. Oral and ocular findings in secondary syphilis. Eye (Lond) 2024:10.1038/s41433-024-03239-2. [PMID: 39030409 DOI: 10.1038/s41433-024-03239-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 05/28/2024] [Accepted: 07/09/2024] [Indexed: 07/21/2024] Open
Affiliation(s)
- Akshay Meena
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vinod Hanumanthu
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Uday Tekchandani
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reema Bansal
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipankar De
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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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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Wu Y, Zhang Y, Li C, Xie Y, Jiang S, Jiang Y, Qiu Y, Luo X, Chen Q. Follicular lymphoma manifests as multiple erosive and proliferative lesions of the oral mucosa: case report and brief literature review. BMC Oral Health 2022; 22:514. [PMCID: PMC9675221 DOI: 10.1186/s12903-022-02567-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/05/2022] [Indexed: 11/21/2022] Open
Abstract
Background Erosion is one of the most common and basic lesions of oral mucosal diseases. Long-term refractory oral erosions, induced by autoimmune blistering diseases, infectious diseases, malignant diseases, and some rare conditions, may substantially reduce the quality of life of patients or even constitute a life-threatening condition, resulting in a clinical dilemma regarding the accurate diagnosis and precise management of these diseases. As a special type of malignant lymphoma, most lesions of follicular lymphoma (FL) in the oral mucosa present as masses or swelling of the oral mucosa, while emerging novel presentations lead to intractable diagnoses. Hence, diagnostic algorithms for such diseases are clinically required. Case presentation A 55-year-old female patient presented to the clinic with long-lasting oral mucosal erosions and proliferative lesions. Blood tests, pathological examinations of oral lesions including haematoxylin–eosin (HE) staining, and direct immunofluorescence precluded all of the potential diagnoses described previously. Unexpectedly, positron emission tomography/computed tomography (PET/CT) and abdominal CT of the patient revealed a dense mass in the retroperitoneal area, and the final diagnosis of the retroperitoneal mass was FL. After three courses of chemotherapy conducted by the haematologist, the erosion and proliferative lesions in the patient's oral mucosa had significantly improved. HE and immunohistochemical staining results of intraoral lesions also confirmed it as oral FL. The successful diagnosis of FL in this case is of great clinical significance, as the oral and abdominal FL were treated in a timely manner to avoid unfavourable outcomes. Conclusions To the best of our knowledge, this is the first case of FL that exhibited widespread erosions interspersed with proliferative lesions. Clinicians should be aware of oral FL or seek systemic factors in the presence of similar refractory oral erosions when treatment is non-responsive and the diagnosis is intractable.
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Affiliation(s)
- Yuqi Wu
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, 610041 Chengdu, China
| | - You Zhang
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, 610041 Chengdu, China
| | - Chunyu Li
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, 610041 Chengdu, China
| | - Yulang Xie
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, 610041 Chengdu, China
| | - Sixin Jiang
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, 610041 Chengdu, China
| | - Yuchen Jiang
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, 610041 Chengdu, China
| | - Yan Qiu
- grid.412901.f0000 0004 1770 1022Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Xiaobo Luo
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, 610041 Chengdu, China
| | - Qianming Chen
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, 610041 Chengdu, China
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4
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Freitas MO, Fonseca APR, de Aguiar MT, Dias CC, Avelar RL, Sousa FB, Alves APNN, de Barros Silva PG. Tumor necrosis factor alpha (TNF-α) blockage reduces acute inflammation and delayed wound healing in oral ulcer of rats. Inflammopharmacology 2022; 30:1781-1798. [PMID: 35948810 DOI: 10.1007/s10787-022-01046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/26/2022] [Indexed: 11/05/2022]
Abstract
Oral traumatic ulcers (OTU) are common in dental routine, and the control of proinflammatory cytokines, such as the tumor necrosis factor-alpha (TNF-α), may interfere with OTU repair. Our aim was to evaluate the role of TNF-α in the healing process of OTU in rats. Wistar male rats were divided into six groups: a control-group (treated with 0.1 mL/kg of saline) and five groups treated with anti-TNF-α infliximab (INF) at 1, 3, 5, 7, and 10 mg/kg immediately before OTU production. The animals were weighed (day 0) and euthanized on days 1, 3, 7, 14 and 21 after ulceration. The ulcers were clinically measured, and the mucosa samples were histologically (scores 0-4), histochemically (collagen assay (pircrosirius)), histomorphometrically (cell counting), and immunohistochemically (TNF-α, α-smooth-muscle-actin (α-SMA), monocyte-chemoattractive-protein-1 (MCP-1), interleukin-8 (IL-8), and fibroblast-growth-factor (FGF)) analyzed. The Evans blue assay was used to measure the vascular permeability. ANOVA-1-2-way/Bonferroni, Kruskal-Wallis/Dunn, and correlation analyses were performed (GraphPad Prism 5.0, p < 0.05). High doses of INF reduced the OTU area (p = 0.043), body mass loss (p = 0.023), vascular permeability (p < 0.001), and reduced delayed histologic scores (p < 0.05), polymorphonuclear (p < 0.001) and mononuclear (p < 0.001) cells, blood vessel counting (p = 0.006), and total (p < 0.001), type-I (p = 0.018), and type-III (p < 0.001) collagen. INF treatment reduced TNF-α immunostaining and delayed MPC-1, FGF, and α-SMA expression, with little/none influence in IL-8 immunostaining. TNF-α blockage by INF reduced acute inflammation in OTU but delayed cell migration and wound healing.
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Affiliation(s)
- Milena Oliveira Freitas
- Department of Dentistry, Unichristus, Rua João Adolfo Gurgel, 133, Cocó, Fortaleza, Ceará, CEP 60192-345, Brazil.,Division of Oral Pathology, Department of Dental Clinic, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | - Maria Thaynara de Aguiar
- Department of Dentistry, Unichristus, Rua João Adolfo Gurgel, 133, Cocó, Fortaleza, Ceará, CEP 60192-345, Brazil
| | - Camila Costa Dias
- Department of Dentistry, Unichristus, Rua João Adolfo Gurgel, 133, Cocó, Fortaleza, Ceará, CEP 60192-345, Brazil
| | - Rafael Linard Avelar
- Division of Oral Pathology, Department of Dental Clinic, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Fabrício Bitu Sousa
- Department of Dentistry, Unichristus, Rua João Adolfo Gurgel, 133, Cocó, Fortaleza, Ceará, CEP 60192-345, Brazil.,Division of Oral Pathology, Department of Dental Clinic, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Ana Paula Negreiros Nunes Alves
- Division of Oral Pathology, Department of Dental Clinic, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Paulo Goberlânio de Barros Silva
- Department of Dentistry, Unichristus, Rua João Adolfo Gurgel, 133, Cocó, Fortaleza, Ceará, CEP 60192-345, Brazil. .,Division of Oral Pathology, Department of Dental Clinic, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil.
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Bindakhil M, Alawi F, France K, Tanaka TI. Primary Syphilis of the Oral Cavity, a Rare Presentation of a Re-Emerging Disease. Cureus 2021; 13:e14595. [PMID: 34036013 PMCID: PMC8137135 DOI: 10.7759/cureus.14595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Syphilis is a sexually transmitted disease caused by microaerophilic spirochete Treponema pallidum. After contact, T. pallidum infiltrates the genital or oral mucosa and spreads systemically throughout the blood and lymphatic systems. Syphilis is classified into stages, with varying signs and symptoms associated with each stage. Primary syphilis has an incubation period of up to 90 days following the sexual transmission of T. pallidum, and is characterized by the development of chancres at the site of inoculation. Rarely, primary syphilis presents in the tongue, which can mimic many other conditions that affect the oral cavity. In this article, we discuss a rare oral manifestation of primary syphilis.
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Affiliation(s)
- Mohammed Bindakhil
- Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, USA
| | - Faizan Alawi
- Division of Dermatopathology, Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Katherine France
- Division of Oral Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Takako I Tanaka
- Division of Oral Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
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Charmelo-Silva S, Kilgore-Rodriguez R, Kurago Z. Painful nonhealing oral ulcers in a 60-year-old male patient. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:260-266. [PMID: 33985922 DOI: 10.1016/j.oooo.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/12/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Scarlet Charmelo-Silva
- Assistant Professor of Oral Medicine, Department of Oral Biology and Diagnostic Sciences, The Dental College of Georgia, Augusta, GA, USA.
| | | | - Zoya Kurago
- Associate Professor of Oral and Maxillofacial Pathology, Department of Oral Biology and Diagnostic Sciences, The Dental College of Georgia, Augusta, GA, USA
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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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Wang X, Chen H, Sun J. Multiple nodules on the scalp as the only cutaneous symptom of secondary syphilis. Int J Dermatol 2019; 58:e203-e204. [PMID: 31236934 DOI: 10.1111/ijd.14564] [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: 05/24/2019] [Accepted: 05/31/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Xiaopo Wang
- Department of Pathology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Hao Chen
- Department of Pathology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Jianfang Sun
- Department of Pathology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
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9
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Del Giudice P. Vegetating lesions in secondary syphilis. Clin Exp Dermatol 2019; 44:469. [DOI: 10.1111/ced.13949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2019] [Indexed: 12/01/2022]
Affiliation(s)
- P. Del Giudice
- Infectiology‐Dermatology Unit Centre Hospitalier Intercommunal de Fréjus Saint Raphaël Fréjus France
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Thakrar P, Aclimandos W, Goldmeier D, Setterfield J. Vegetating lesions in secondary syphilis. Reply from authors. Clin Exp Dermatol 2019; 44:469-470. [DOI: 10.1111/ced.13965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 11/29/2022]
Affiliation(s)
- P. Thakrar
- Department of Oral Medicine Guy's and St Thomas’ NHS Foundation Trust London UK
| | - W. Aclimandos
- Department of Ophthalmology King's College Hospital London UK
| | - D. Goldmeier
- Department of Genitourinary Medicine Imperial College NHS Healthcare Trust London UK
| | - J.F. Setterfield
- Department of Oral Medicine Guy's and St Thomas’ NHS Foundation Trust London UK
- Centre for Host‐Microbiome Interactions King's College London Faculty of Dentistry, Oral and Craniofacial Sciences London UK
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