Primary Syphilis Presenting As a Chronic Lip Ulcer

Abstract

Syphilis is usually a sexually transmitted infection caused by the spirochete Treponema pallidum. Primary syphilis classically presents as a painless, ulcerated lesion on the genitals. However, the primary lesion is not restricted to this site and appears wherever the spirochete enters through the skin. The symptomatology and appearance of the primary lesion can also vary. We present a case of a 59-year-old man with a primary syphilitic chancre of the lower lip. The patient was referred to the dermatology clinic by their primary care provider after the ulceration failed to heal with antibiotic therapy. A biopsy of the lesion was taken at this time; the diagnosis of syphilis was then made by histologic examination and immunohistochemical staining. Subsequent serologic tests were also positive. Upon prompting, the patient did report a history of sexually transmitted disease but not of syphilis specifically. The patient was treated with penicillin, and there was clinical improvement of the lesion at the follow-up visit.

Cocaine-Induced Plasma Cell Orificial “Dermatomucositis”: A More Accurate Descriptive Term for a Clearly Dermatological Entity

“…The first recommended technique is the use of immunohistochemistry for Treponema. The presentation of syphilis with involvement of the upper lip is a characteristic clinical profile in the literature, serving as a manifestation of primary syphilis (chancre), secondary syphilis, [4][5][6][7][8][9][10] and even tertiary syphilis. 11,12 In some cases, there may be no evidence of sexual transmission.…”

Sífilis la gran imitadora. Reporte de caso y revisión de la literatura

“…Se recomienda que, hombres que tienen sexo con otros hombres, se realicen la prueba anualmente y, si hay más factores de riesgo asociados, como numerosas parejas o sexo combinado con drogas ilícitas, realizar la prueba cada 3 meses (13,24) . Debido a que clínicamente puede confundirse con diferentes estados patológicos de la cavidad bucal tales como tuberculosis oral, ulceraciones aftosas, linfomas, sialometaplasia necrotizante, COCE, entre otros (16,(25)(26)(27) , y sobre todo cuando la lesión es el único signo de la enfermedad puede ser necesario realizar una biopsia, en la cual, un infiltrado inflamatorio rico en células plasmáticas debe sugerir el diagnóstico, lo que induce al estudio inmunohistoquímico con anticuerpo anti-Treponema, donde es posible observar las espiroquetas para confirmar sífilis (28,29) . Así mismo, es de utilidad el uso de BAAF de los nodos linfoides afectados, que en nuestro caso permitió descartar malignidad y confirmar una adenopatía reactiva, que sumada a las pruebas serológicas se obtuvo el diagnóstico definitivo de sífilis.…”

Plasma cell-rich lesions in the oral cavity: an overview and case presentation

“…Generally, the surface epithelium is ulcerated in primary lesions and may be ulcerated or hyperplastic with an extensive exocytosis of neutrophils in the secondary stage. A chronic inflammatory infiltrate, constituted predominantly by plasma cells in the connective tissue is noted primarily in the subepithelial region, around vascular channels and as perineural infiltrate (18)(19)(20)(21)(22)(23)(24)(25)(26).…”