Oral Syphilis: Case Report of a Re-Emerging Disease

Abstract

Syphilis caused by Treponema pallidum is a re-emerging disease, with a recent increase in the number of reported cases. Oral lesions, although unusual, can occur at any stage of the disease. A 22-year-old man, under hormonal treatment for sex change, with a history of hepatitis and syphilis, presented with a complaint of pain in the tongue. Intraoral examination revealed painful whitish plaques on the tongue, permeated by small ulcerations. Histologic examination after incisional biopsy revealed fragments of mucosa partially covered by parakeratinized stratified squamous epithelium, with areas of hyperplasia, exocytosis, and ulceration covered by fibrinopurulent membrane. The lamina propria contained a subepithelial band of intense inflammatory infiltrate predominantly composed of plasma cells, which were also found around the blood vessels and nerves. The final diagnosis was syphilis; the patient was referred for treatment. However, because of a homeless situation and social marginalization, the patient avoided return visits.