Intractable Stomatitis Accompanied with Cervical Lymphadenopathy: An Unusual Manifestation of Secondary Syphilis

Abstract

Intractable stomatitis remains a diagnostic challenge for clinicians since many disease entities involve oral and oropharyngeal mucosa. Isolated oropharyngeal lesion without general manifestations as a consequence of syphilis is rare. We report a case of intractable oropharyngeal ulcer combined with cervical lymphadenopathy as the presentation of secondary syphilis. A 30-year-old male presented with a whitish and painless oropharyngeal lesion for more than three months. Physical examination showed extensive, smooth and white plaques on an erythematous base involving the soft palate, uvula, and anterior pillars. Multiple lymph nodes, up to 3 cm in diameter, were also palpable at the upper neck. Pathological examinations of oropharyngeal lesion and lymph node displayed a mixed cellular infiltrate with plasma cells, a perivascular lymphocytic infiltrate, and obliteration of the vessels. However, a Warthin-Starry stain failed to demonstrate any microorganisms. Immunohistochemistry for detection of ＂Treponema pallidum＂ revealed microorganisms in biopsy samples. The results of VDRL and TPHA serum test were positive. Secondary syphilis was then diagnosed, although the patient had no lesions on the genital organ or oral cavity early on. He was treated with intramuscular benzathine penicillin with full resolution of the oropharyngeal lesion and neck nodes within one week. We suggest that secondary syphilis should be considered while treating intractable isolated oropharyngeal lesion without general manifestations. Serological tests and immunohistochemistry of biopsy samples are helpful for these patients.