ORAL SYPHILIS: A REPORT OF TWO CASES AND A LITERATURE REVIEW OF THIS RE-EMERGING ENTITY

Abstract

Objective Syphilis is a sexually transmitted, infectious disease caused by Treponema pallidum. It can manifest clinically in three stages: primary, secondary, and tertiary. While rare, oral syphilis cases are starting to re-emerge. Our objective is to report 2 additional cases of oral syphilis—one case of primary syphilis and 1 case of secondary syphilis—to highlight the need to consider this entity in the histopathologic differential diagnosis of nonspecific mucositis. Findings Both cases presented to outside oral surgeons in separate geographic regions. In case 1, a 25-year-old male presented with a six-week history of a 1.0 cm non-healing ulcer of the right lateral tongue. In case 2, a 28- year-old male presented with welt-like, slightly raised, red/white lesions of the lateral tongue, buccal mucosa, and hard and soft palates. The clinician reported no other lesions on the body and a negative STD test. An excisional biopsy was performed for case 1 and an incisional biopsy for case 2. Histopathologically, case 1 showed an ulcer with an underlying lichenoid lymphoplasmacytic infiltrate with perivascular plasma cells. Case 2 showed epithelial spongiosis and prominent neutrophilic microabscesses with an underlying lichenoid lymphoplasmacytic infiltrate. Perivascular and perineural plasma cells were also present. Because of the perivascular plasma cells in both cases, Treponema immunohistochemistry was ordered, and it highlighted many spirochetal organisms in the epithelium and superficial lamina propria in both cases. Given their respective clinical presentations, case 1 was diagnosed as a chancre of primary syphilis, while case 2 was diagnosed as a mucous patch of secondary syphilis. Conclusion Due to the resurgence of oral syphilis cases, clinicians should be aware of the histopathologic features and order the appropriate ancillary studies in suspected cases. Proper histopathologic diagnosis is important to prevent the spread and further re-emergence of this treatable infection and avoid misdiagnosis as nonspecific mucositis.