Clinicopathologic features, microvessel density, and immunohistochemical expression of ICAM-1 and VEGF in 15 cases of secondary syphilis with oral manifestations

Reemerging syphilis: diagnosis from oral lesions

“…Although oral lesions and skin manifestations may occur at any stage of the disease, they are mainly associated with secondary syphilis 13,14 , which occurs in approximately 30% of untreated patients. In this phase, several systemic and mucocutaneous manifestations of the disease, such as fever, malaise, weight loss, pharyngitis, and lymphadenopathy 5,6,14,15 occur.…”

“…In this phase, several systemic and mucocutaneous manifestations of the disease, such as fever, malaise, weight loss, pharyngitis, and lymphadenopathy 5,6,14,15 occur. Some of these events were reported by our patient, additionally to hair, eyebrows, and eyelashes loss, which have been reported in about 5-6% of the patients with syphilis 5 .…”

“…In addition, approximately 75% of patients with secondary syphilis develop skin manifestations 16 . Its most common presentation is called syphilitic roseola which is characterized by symmetrical, asymptomatic, and pink or red macules that last about two weeks and usually affect the trunk and extremities 5,14 . The skin lesions from our patient were diagnosed as pityriasis rosea by a dermatologist, but we assume that these lesions were suggestive of syphilitic roseola, which is the first clinical sign of secondary syphilis and accompanying oral lesions 2,17 .…”

“…Different from primary syphilis, that is presented as a single painless chancre, the oral lesions of secondary syphilis are usually symptomatic and multiple 11 . The most common oral lesions associated with secondary syphilis are ulcers or erosions and "mucous patches" with two subtypes: slightly elevated-type plaques with ulcerated surface occasionally; or multiple mucous patches that may coalesce to give rise to serpiginous lesions, described as snail track ulcers [4][5][6][12][13][14] . As seen in our patient, the usually affected sites are soft palate, tongue, lips, buccal mucosa, and vestibular mucosa 5,14 .…”

“…In this report, the initial clinical diagnostic hypotheses were immune-mediated diseases based on clinical characteristics of the lesions with periods of remission and exacerbation and also in her medical history. The differential diagnosis of oral lesions of secondary syphilis includes lupus erythematosus, erythema multiform, stomatitis, pemphigus, idiopathic leukoplakia, lichen planus, candidiasis, and other STD 2,5,6,14,18 . The confirmation of syphilis diagnosis is based on clinical signs and symptoms, sexual history, and specific serologic tests 6 .…”