ORAL SYPHILIS IN AN ADULT PATIENT WITH AN INITIALLY VDRL NEGATIVE TEST

Abstract

We report an uncommon presentation of oral syphilis in a male patient, 29 years old with a 2-month mouth ulcer. Clinical examination showed right submandibular lymphadenopathy and a painless ulcer located on the right labial commissure. Serology was requested for syphilis (VDRL) and HIV—both nonreactive—and a complete blood count that showed no changes. An incisional biopsy was performed with a diagnosis of an inflammatory process. Histochemical stains, such as Ziehl Nielsen and PAS, were requested, in addition to serology for toxoplasmosis and histoplasmosis, which were all nonreactive. Two months later, due to the persistence of the lesion, FTA-ABS and VDRL were requested again, and both were positive, characterizing syphilis. Afterward, treatment with benzathine penicillin 1,200,000 UI (2 applications/3 weeks) was proposed, and the patient remains in follow-up.