Secondary Syphilis Occurring on the Tongue: Report of a Case

Abstract

<h3>Objective</h3> According to the Centers for Disease Control the rate of syphilis has steadily increased nearly every year since 2001. Tertiary syphilis is associated with serious complications that can be avoided by early diagnosis and treatment. Although primary and secondary syphilis typically involve the genitals, the oral cavity may be the initial site of disease. Given the recent increase in incidence, it is critical to recognize this disease to aid in prevention of life-threatening complications. Here, we report a case of oral syphilis and present the clinical, histopathological and immunohistochemical features. <h3>Clinical Presentation</h3> A 21-year-old female presented to an oral and maxillofacial pathologist for evaluation of a lesion on the tongue of one-month duration. Her medical diagnoses included bipolar disorder and genital herpes. Her social history included smoking and cocaine abuse. Upon examination, a mildly erythematous elevated plaque of the posterior dorsal tongue measuring 2.0 × 1.5 cm was identified. <h3>Intervention and Outcome</h3> An incisional biopsy was performed under intravenous sedation by an oral and max- illofacial surgeon. Microscopic review showed oral mucosa demonstrating papillary hyperparakeratosis, neu- trophilic microabscesses and a moderateto-intense chronic inflammatory infiltrate possessing an abundance of plasma cells in the underlying connective tissues. These features were suspicious for a diagnosis of secondary syphilis. Tissue was sent to the Mayo Clinic for <i>Treponema pallidum</i> study by immunohistochemistry. Review of the stained slides showed numerous spirochetal organisms throughout the epithelium, confirming the diagnosis. The patient's primary care provider was contacted to initiate therapy. The NYC Department of Health and Mental Hygiene was notified of this diagnosis fulfilling mandatory reporting requirements. <h3>Conclusion</h3> The rate of syphilis diagnosis is on the rise. Presentation in the oral cavity, while rare, is important for oral healthcare providers to be familiar with as early diagnosis and treatment are likely to prevent serious complications.