A 39-year-old woman presented with a 6-week history of an ulcerated and indurated lesion in the upper lip (Fig. 1). The histological study showed an ulcer with dense lymphoplasmacytic infiltrate and the immunohistochemistry (IHC) was positive for spirochetes. Both, the rapid plasma reagin test (RPR) and the microhemaglutination of the Treponema pallidum (MHA-TP) test were reactive with a RPR of 1:32.
Due to physical examination, biopsy, IHC and laboratory tests (MHA-TP and RPR) the patient was diagnosed with primary syphilis. Infective syphilis is caused by T. pallidum, an anaerobic filamentous spirochete.11. Leão JC, Gueiros LA, Porter SR. Oral manifestations of syphilis. Clin São Paulo Braz. 2006;61:161–6. The primary stage is known as syphilis chancre.22. Ficarra G, Carlos R. Syphilis: the renaissance of an old disease with oral implications. Head Neck Pathol. 2009;3:195–206. The mouth is a rare place of presentation of syphilis chancre, with 10–20% of cases intrarectal, perianal or oral lesions.22. Ficarra G, Carlos R. Syphilis: the renaissance of an old disease with oral implications. Head Neck Pathol. 2009;3:195–206. The treatment of primary syphilis is intramuscular benzathine penicillin.33. Dylewski J, Duong M. The rash of secondary syphilis. CMAJ Can Med Assoc J. 2007;176:33–5. The patient and his partner were treated with 2,400,000, intramuscular benzathine penicillin with a complete resolution of the lesion (Fig. 2).
REFERENCES
-
1Leão JC, Gueiros LA, Porter SR. Oral manifestations of syphilis. Clin São Paulo Braz. 2006;61:161–6.
-
2Ficarra G, Carlos R. Syphilis: the renaissance of an old disease with oral implications. Head Neck Pathol. 2009;3:195–206.
-
3Dylewski J, Duong M. The rash of secondary syphilis. CMAJ Can Med Assoc J. 2007;176:33–5.
Publication Dates
-
Publication in this collection
Sept-Oct 2014
History
-
Received
25 Mar 2014 -
Accepted
28 Mar 2014
