Syphilis has been increasing in incidence during the last few years and its early presentation may be the oral cavity (40–75%), so it is increasingly becoming a differential diagnosis in routine oral pathology.
A 29-year-old female with no major medical conditions was visited for painful erythematous areas on the cheeks and mandibular vestibules, painless a specific ulceration on right border and dorsum of the tongue and marginal painful gingivitis, recently treated with scaling and root planing, without purulent aspect.
There were neither regional lymphadenopathy nor coutaneous manifestation.
The patient, HIV-negative, reported usual oral sex.
Differential diagnosis were considered: erythema multiforme (caused by 5-day therapy with paracetamol and undefinited FANS after additive mammoplasty), herpetic gingivostomatitis, recurrent aphthous stomatitis, Behçet’s syndrome and aspecific ulcerations.
The following investigations were performed: tongue’s right border punch biopsy ( 5mm diameter ) for histological examination, cheek’s left biopsy for direct immunofluorescency (DIF) and PCR for DNA investigation of bacteria and virus.
Histologic examination revealed endothelial cellular proliferation within small arteries and arterioles and an inflammatory infiltrate with mature plasma cells, in perivascular distribution or as a band-like infiltrate in the lamina propria. In addition, molecular testing (PCR) revealed the presence of numerous intraephitelial treponemes, while DIF proved to be non-diagnostic.
Several clinical tests have ruled out other infected sites, and the patient was treated with a single intramuscular injection of benzathine penicillin G (2.4 million UI). The lesion completely resolved during a 4-week period.
A missed diagnosis can often lead to serious complications for the patient and dental care workers (DCWs) because, unlike other sexually transmitted diseases, syphilis is easily transmissible in early oral presentation.
References
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