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Iijima H, Sakai A, Ebisumoto K, Yamauchi M, Maki D, Teramura T, Saito K, Yamazaki A, Inagi T, Yamamoto A, Ashida H, Sato Y, Sato S, Okami K. A retrospective analysis of syphilis cases with a focus on otolaryngology at a university hospital. Auris Nasus Larynx 2024; 51:1016-1024. [PMID: 39454247 DOI: 10.1016/j.anl.2024.09.009] [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: 05/08/2024] [Revised: 09/21/2024] [Accepted: 09/30/2024] [Indexed: 10/28/2024]
Abstract
OBJECTIVES In recent years, there has been a notable increase in syphilis cases in Japan and Western countries. Syphilis, a classic sexually transmitted disease caused by treponemas, presents diagnostic challenges due to its diverse clinical manifestations. This study explores the diagnosis of syphilis in patients treated at our hospital. METHODS We retrospectively reviewed patients who visited our hospital between April 2015 and March 2024. The review focused on the patients' clinical backgrounds, onset times, symptoms, diagnostic processes, and clinical courses. RESULTS Our hospital had 45 cases of syphilis. Forty-five cases of syphilis were diagnosed as syphilis in our hospital (13 cases were diagnosed in the Otolaryngology: ENT department). The median age was 40 years, with a significant male predominance (male-to-female ratio of 34:11). The median duration from the onset of subjective symptoms to syphilis diagnosis was 54 days. The timeframe from the initial clinic visit to diagnosis ranged from 1 to 57 days, with a median of nine days. Notably, 47.5% of the patients reported a history of employment or patronage in the sex industry. 73.3% of patients presented to local clinics with any kind of subjective symptoms, but syphilis was often missed in the differential diagnosis. Patients visiting the ENT department were referred to our hospital with a diagnosis of persistent oral ulcer, oropharyngeal carcinoma and neck lymphadenopathy. Histological and cytological evaluation was performed in 33% of patients, but the diagnosis was often difficult to make. Additionally, some patients initially denied using sex services at their first visit but later disclosed this during subsequent visits to the Department of Infectious Diseases, highlighting the critical role of thorough medical history assessments. CONCLUSION Diagnosing syphilis can be challenging unless the physician specifically suspects it. It is crucial to consider syphilis in cases of pharyngeal mucosal inflammation and neck lymphadenopathy. This study highlights the need for heightened awareness and education regarding the signs and symptoms of syphilis, particularly oropharyngeal and skin findings, to ensure timely diagnosis and treatment.
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Affiliation(s)
- Hiroaki Iijima
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan.
| | - Akihiro Sakai
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Koji Ebisumoto
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Mayu Yamauchi
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Daisuke Maki
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Takanobu Teramura
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Kosuke Saito
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Aritomo Yamazaki
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Toshihide Inagi
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Ai Yamamoto
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Hiroshi Ashida
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Yurina Sato
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
| | - Shota Sato
- Department of General Medicine, Infectious Disease Team, Tokai University, School of Medicine, Isehara, Japan
| | - Kenji Okami
- Department of Otolaryngology, Head and Neck Surgery, Tokai University, School of Medicine, Isehara, Japan
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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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Jerrold L. It’s a secret. Am J Orthod Dentofacial Orthop 2022; 162:429-431. [DOI: 10.1016/j.ajodo.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 11/17/2022]
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Magnaterra E, Grandi V, Pisano L. The Great Imitator: Primary Syphilis Clinically Mimicking Oral Squamous Cell Carcinoma. Am J Med 2022; 135:1078-1079. [PMID: 35307358 DOI: 10.1016/j.amjmed.2022.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/04/2022] [Accepted: 02/13/2022] [Indexed: 11/01/2022]
Affiliation(s)
| | - Vieri Grandi
- Dermatology Unit, Department of Health Sciences, University of Florence, Italy
| | - Luigi Pisano
- Dermatology Unit, Department of Health Sciences, University of Florence, Italy
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Camps G, Pavelchek C, Eldaya R, Parsons M. Novel radiographic presentation of primary syphilis of the tonsil. Radiol Case Rep 2021; 16:3217-3221. [PMID: 34484522 PMCID: PMC8405937 DOI: 10.1016/j.radcr.2021.07.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 11/05/2022] Open
Abstract
A 61-year-old HIV+ male presented to an infectious disease clinic with a complaint of sore throat. A painless ulcerated mass was discovered on the right tonsil resulting in further evaluation with a CT scan of the neck. Imaging confirmed the presence of a mass centered on the palatine tonsil and associated lymphadenopathy. A presumptive diagnosis of HPV-related squamous cell carcinoma was made due to patient risk factors. However, multiple biopsies found no evidence of carcinoma, but instead revealed the presence of spirochetes that stained positive for T Pallidum. Soon after, the patient developed the characteristic copper-red maculopapular rash of secondary syphilis, indicating that the tonsillar mass was, in fact, a primary chancre. Since such chancres are most often found externally in the genital or anal region, they are seldom radiographically characterized, placing them low on the differential diagnosis for most radiologists. A high index of suspicion could aid future radiologists in placing primary syphilis higher on the differential diagnosis in similar cases in which the patient has appropriate risk factors, such as a known history of genital-oral sexually transmitted infections or an immunocompromised state. Prompt recognition of the nature of a primary syphilitic lesion can lead to rapid resolution of symptoms following treatment with intramuscular benzathine penicillin G, as eventually occurred in this case.
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Affiliation(s)
- Garrett Camps
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Cole Pavelchek
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Rami Eldaya
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Matthew Parsons
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
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Deng F, Thompson LDR, Lai J. Unexpected Reason for Non-healing Oral Ulcers: Syphilis. Head Neck Pathol 2021; 16:544-549. [PMID: 34342809 PMCID: PMC9187837 DOI: 10.1007/s12105-021-01348-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/11/2021] [Indexed: 02/05/2023]
Abstract
Syphilis is a sexually transmitted infectious disease caused by Treponema pallidum and characterized by a complex and variable clinical presentation. Cases of unexpected oral syphilis presenting as non-healing ulcers are uncommonly reported. We report 3 cases (one female and two males, aged 35, 35, and 56 years, respectively) in which patients presented with non-healing oral ulcers. Biopsies revealed surface ulceration and a significant neutrophilic infiltrate rather than the more conventional plasma cell infiltrate seen with most reported syphilis infections, potentially leading to an inaccurate diagnosis. Treponema pallidum immunohistochemistry highlighted spirochetes within the epithelium, with additional diagnostic confirmation by serum T. pallidum particle agglutination assay. Sexual history documentation by the clinician with nonspecific oral ulcers is paramount to aiding diagnosis and leading to proper management. Further, it is important to perform immunohistochemistry for T. pallidum in oral biopsies from non-healing ulcers, especially when clinical history raises the differential diagnosis or when other clinical manifestations may support this consideration.
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Affiliation(s)
- Frank Deng
- Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Lester D. R. Thompson
- Department of Pathology, Woodland Hills Medical Center, Southern California Permanente Medical Group, Woodland Hills, CA USA
| | - Jinping Lai
- Department of Pathology, Kaiser Permanente Sacramento Medical Center, 2025 Morse Ave, 95825 Sacramento, CA USA
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Sil A, Bhanja DB, Panigrahi A, Mondal S, Chakraborty S. Secondary syphilis presenting as oral ulcers. Arch Dis Child 2021; 106:282. [PMID: 31900252 DOI: 10.1136/archdischild-2019-318391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Abheek Sil
- Department of Dermatology, Venereology, and Leprosy, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Dibyendu Bikash Bhanja
- Department of Dermatology, Venereology, and Leprosy, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Avik Panigrahi
- Department of Dermatology, Venereology, and Leprosy, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Satarupa Mondal
- Department of Dermatology, Venereology, and Leprosy, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Sayantani Chakraborty
- Department of Dermatology, Venereology, and Leprosy, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
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Leite MGM, Freitas EDS, de Vasconcelos Ii AJA, Pinheiro TN. Low-Level Laser Therapy Approach of Bilateral Necrotizing Sialometaplasia of the Hard and Soft Palates. J Lasers Med Sci 2020; 11:348-354. [PMID: 32802297 DOI: 10.34172/jlms.2020.56] [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: 01/04/2023]
Abstract
Introduction: Necrotizing sialometaplasia (NS) is a rare locally destructive inflammatory benign disease that commonly affects the minor salivary glands. It is frequently associated with the glands located in the posterior portion of the hard and soft palates. Low-level laser therapy (LLLT), also called photobiomodulation therapy (PBMT), has been deemed a substantial method for the regenerative wound process. Case Presentation: A 32-year-old male patient was referred with a chief complaint of two asymptomatic crater-like ulcers measuring approximately 1.5 cm wide on the right side of the hard and soft palates, and another measuring 0.3 cm wide on the left side of the hard palate. The lesion had two weeks of evolution followed by a previous infectious "sore throat" event that kept the patient hospitalized for 4 days. A clinical diagnosis of NS was made. LLLT was applied during 2 sessions per week, favoring the total wound healing within 2 weeks. At 3 months of clinical followup, the patient did not present any complication or relapse and was thus released. Conclusion: This is, to our knowledge, the first clinical report of LLLT applied for the management of NS. Large palatal ulcers caused by NS usually have long healing periods. The shortened healing period observed in this case encourages the inclusion of LLLT in any treatment protocol for similar lesions.
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Affiliation(s)
- Milena Gomes Melo Leite
- Undergraduate Student, Superior School of Health Science, Amazonas State University, Av. Carvalho Leal, 1777, Cachoeirinha, Manaus-AM, 69065-001, Brazil
| | - Eliandro de Souza Freitas
- Undergraduate Student, Superior School of Health Science, Amazonas State University, Av. Carvalho Leal, 1777, Cachoeirinha, Manaus-AM, 69065-001, Brazil
| | | | - Tiago Novaes Pinheiro
- DDS, MSc, PhD, Superior School of Health Science, Amazonas State University, Av. Carvalho Leal, 1777, Cachoeirinha, Manaus-AM, 69065-001, Brazil
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