Mucocutaneous Lesions Research Articles

Mucocutaneous involvement in behçet’s disease

Behçet's disease is a chronic inflammatory disease characterized by its clinical polymorphism associating mucocutaneous involvement to systemic manifestations. The mucocutaneous lesions are considered the hallmark of the disease, being the most common symptoms presenting at the onset of disease. Our objective was to determine the characteristics of this skin involvement during Behçet's disease. We conducted a descriptive study over a period of 30 years, having collected all patients with Behçet's disease. These were 98 patients. A male predominance was observed in our studied population with a Sex Ratio of 2.5. The mean age at diagnosis was 34 years. Mucocutaneous involvement was observed in all patients. Oral aphthosis was constant and genital ulcers, were observed in 81 cases. The other mucocutaneous manifestations were: pseudofolliculitis (61 cases), erythema nodosum (7 cases), skin ulcers (4 cases), acneiform lesions (2 cases), perianal ulcers (1 case), skin ulceration (1 case) and erythema multiforme. (1 case). All of our patients were treated with colchicine. Corticosteroids and non-steroidal anti-inflammatory drugs were each indicated in one case for resistant forms.

MUCO-CUTANEOUS MANIFESTATIONS IN HIV INFECTED CHILDREN AND ITS CORRELATION WITH THE CD4 COUNT

Background Dermatological manifestations increase both in frequency and severity with the progression of HIV and thus can serve as important markers of disease progression. Early recognition of such dermatological manifestations is important for an early diagnosis and also to assess the prognosis of HIV infection Objective The objective was to determine the cutaneous manifestations among HIV children and its correlation to clinical staging and the level of immunosuppression. Material and Methods The study was a cross sectional study conducted in the Department of Pediatrics, Dr. RML Hospital, New Delhi. The study population included all the HIV infected children.A total of 102 study participants were recruited. Absolute counts of CD4,CD8 and ratio of CD4/CD8 and Tzanck smear, KOH preparation, and skin scrapings was done. Chi square tests and independent t test was applied. P value of <0.05 is considered to be significant. Results The age of study participants ranged from one and half years to 17 years with a mean(SD) of 10.54 (± 11). The median age was 3.58. Males were 73.5% and females were 26.5%. Most of the patients were in WHO stage I. Prevalence of mucocutaneous manifestation was 16.7%. Lower mean CD4 counts and lower total leucocyte counts were associated with higher incidence of mucocutaneous lesions. (p value <0.05) Conclusion The prevalence of muco cutaneous manifestation increases with decline in CD4 count. Hence muco cutaneous manifestations can be taken as the marker of deteriorating immune status of patients.

Intralesional injection of biosimilar rituximab in recalcitrant mucocutaneous lesions of patients with pemphigus vulgaris: A pilot study.

The efficacy of intravenous rituximab (RTX) in patients with pemphigus have been shown in the previous studies. The study aimed to investigate the effectiveness of intralesional injection of RTX in the healing of pemphigus lesions, with lower doses and probable better safety profile than intravenous RTX. Eleven Pemphigus patients with recalcitrant lesions received two intralesional injections of biosimilar RTX, 5 mg/cm2 . During 6 months follow-up, Pemphigus Disease Area Index, the patients' satisfaction, quality of life, the disease activity, the number and size of lesions, the anti-desmoglein (Dsg) 1 and 3 antibodies and the count of CD4+ and CD19+ cells were assessed. All patients were in partial remission on therapy. The absolute count of CD19+ B cells showed a statistically significant decline (P = .006). The percentage of CD4 + T lymphocytes increased 2 weeks after injection and decreased 2 weeks later (P = .01). The average number and size of lesions decreased. The concentration of anti-Dsg 3 antibody decreased insignificantly during the study. The severe pain during the injection was considered as the main complication. At the end of the study, two patients were in complete remission on therapy, and the other nine remained in partial remission on therapy. Few side effects resulting from intralesional injection of RTX and enhanced quality of life of the patients were considered as the valuable achievements of this study. The results showed that although a low dose of RTX leads to a significant decrease of CD19+ B lymphocytes, it did not show parallel clinical effectiveness.

Temporal trends of cutaneo-mucous histoplasmosis in persons living with HIV in French Guiana: Early diagnosis defuses South American strain dermotropism.

Histoplasmosis is the most frequent opportunistic infection and the first cause of mortality in HIV-infected patients in French Guiana and presumably in much of Latin America. Mucocutaneous lesions of histoplasmosis are considered as rare and late manifestations of the disease. It has been debated whether the greater proportion of cutaneo-mucous presentations in South America relative to the USA was the reflection of Histoplasma strains with increased dermotropism or simply delayed diagnosis and advanced immunosuppression. The objective of this study was to describe the clinical presentation, frequency, prognosis and temporal trends of cutaneomucous histoplasmosis in French Guiana. A retrospective study of patients with AIDS-related disseminated histoplasmosis followed in the three hospitals of French Guiana was performed between 1981 and 2014. Incident cases of histoplasmosis, proved by pathology and/or mycological examinations, were studied. Mucocutaneous histoplasmosis was confirmed by a positive cutaneous or mucosal biopsy. Mucocutaneous lesions were polymorphic. Ninety percent of patients were profoundly immunocompromised patients (CD4<50/mm3) and over 80% were not on antiretroviral treatment. The frequency of mucocutaneous forms and case fatality of disseminated histoplasmosis within one month of antifungal treatment significantly decreased over time (p<0,001). In this South American territory, diagnostic and therapeutic improvements have led to the quasi disappearance of cutaneous manifestations. There may be South American dermotropism in the laboratory but at the bedside early diagnosis seems to be the main parameter explaining the proportion of cutaneomucous presentations in South America relative to the USA.

Langerhans Cells Suppress CD8+ T Cells In Situ during Mucocutaneous Acute Graft-Versus-Host Disease

Acute graft-versus-host disease (aGVHD) induced by allogenic hematopoietic stem cell transplantation is an immunological disorder in which donor lymphocytes attack recipient organs. It has been proven that recipient nonhematopoietic tissue cells, such as keratinocytes, are sufficient as immunological targets for allogenic donor T cells, whereas Langerhans cells (LCs) are potent professional hematopoietic antigen-presenting cells existing in the target epidermis and eliminated during the early phase of mucocutaneous aGVHD. Moreover, LCs have been reported to negatively regulate various types of immune responses. Here, we present data showing that initial depletion of recipient LCs exacerbates mucocutaneous lesions in a murine model of allogenic bone marrow transplantation-induced aGVHD. Furthermore, another murine model of mucocutaneous aGVHD induced in mice with keratinocytes genetically expressing chicken ovalbumin by transfer of ovalbumin-specific CD8+ OT-I cells also showed that LC-depleted recipient mice develop aggravated mucocutaneous disease owing to decreased apoptosis of skin-infiltrating OT-I cells. Moreover, coexisting LCs directly induce apoptosis and inhibit the proliferation of OT-I cells invitro partially via B7 family proteins. Collectively, our results indicate that LCs negatively regulate mucocutaneous aGVHD-like lesions in situ by inhibiting the number of infiltrating CD8+ T cells.

Oral Lichen Planus in Kashmiri Population-a clinical prospective study

Objectives: The purpose of this clinical prospective study was to determine the location, clinical presentation, and gender distribution of oral lichen planus patients attending the department of oral medicine and radiology, Government dental college Srinagar in Kashmiri population. Materials and Methods: This prospective clinical study included 200 patients reported to the Department of Oral Medicine and Radiology, Government Dental College Srinagar, with the clinical and pathological diagnosis of OLP. Data was compiled for each case, documenting information relating to age, gender, medication, habits(smoking, oral hygiene), anamnesis (reason for consultation, symptomatology, evolution. Results: Out of 200 patients, 116 (58%) were females and 84(42%) were males indicating higher prevalence of OLP in females. Buccal mucosa being the most common site affected in 132 patients (66%), followed by tongue in 46 patients (23%) and the least frequent involved site was palate in 2 patients (1%).The most common clinical presentation was of reticular type in 128 patients (64%), and the least common was bullous type in 3 patients (1.5%). Conclusion: Lichen planus is one of the mucocutaneous disorders which involve skin, scalp, nails and oral mucosa. Lichen planus of skin is known as cutaneous lichen planus that is characterized by most common symptoms of pigmented cutaneous lesions which are pruritic. For a general practitioner it is very important to know the important clinical features, diagnosis and treatment plan for this disease in order to differentiate it from other mucocutaneous lesions and to educate the patient about the premalignant nature of disease. Keywords: Greenspan syndrome, Wickham striae, Nikolsky’s sign.

Mucocutaneous involvement in behçet’s disease

Behçet's disease is a chronic inflammatory disease characterized by its clinical polymorphism associating mucocutaneous involvement to systemic manifestations. The mucocutaneous lesions are considered the hallmark of the disease, being the most common symptoms presenting at the onset of disease. Our objective was to determine the characteristics of this skin involvement during Behçet's disease. We conducted a descriptive study over a period of 30 years, having collected all patients with Behçet's disease. These were 98 patients. A male predominance was observed in our studied population with a Sex Ratio of 2.5. The mean age at diagnosis was 34 years. Mucocutaneous involvement was observed in all patients. Oral aphthosis was constant and genital ulcers, were observed in 81 cases. The other mucocutaneous manifestations were: pseudofolliculitis (61 cases), erythema nodosum (7 cases), skin ulcers (4 cases), acneiform lesions (2 cases), perianal ulcers (1 case), skin ulceration (1 case) and erythema multiforme. (1 case). All of our patients were treated with colchicine. Corticosteroids and non-steroidal anti-inflammatory drugs were each indicated in one case for resistant forms.

Multicentric Reticulohistiocytosis Exhibiting Positive HLA-B*07 and HLA-B*08: A Case Report

Multicentric reticulohistiocytosis (MRH) is a rare cause of destructive inflammatory arthritis involving both small, as well as larger joints. We report the case of a 40-year-old Caucasian female with a family history of neoplasia who was referred to our service witha two-month history of inflammatory joint pain. On examination, the patient had inflammatory arthritis, mainly involving the peripheral joints, sacroiliac joint pain, and numerous papulonodular mucocutaneous lesions, including periungual “coral beads”. Imaging tests revealed erosive arthritis with synovitis and tenosynovitis, sacroiliac joint changes, as well as papulonodular mucosal lesions in the nasal vestibule, the oropharyngeal mucosa, and supraglottic larynx. She tested positive for HLA-B*07 (Human Leukocyte Antigen B*07) and HLA-B*08, ANA (antinuclear antibodies), RF (rheumatoid factor), anti-Ro52, anti-SSA/Ro, and anti-SSB/La antibodies. The skin biopsy was suggestive of MRH, showing a histiocyte infiltrate and frequent giant multinucleated cells. The patient exhibited favorable outcomes under Methotrexate, then Leflunomide. However, she displayed worsening clinical symptoms while under Azathioprine. To our knowledge, this is the first case of MRH to exhibit positive HLA-B*07 together with HLA-B*08. The rarity of MRH, its unknown etiology and polymorphic clinical presentation, as well as its potential neoplastic/paraneoplastic, and autoimmune nature demand extensive investigation.

MUCOCUTANEOUS REACTIONS TO DRUGS: 3 CASE REPORTS

Stevens-Johnson syndrome (SSJ) and a toxic epidermal necrolysis (NET) are mucocutaneous reactions to drugs. Three cases of pharmacodermia are presented here. CASE 1: AGSS, 13, with SSJ with face, chest, perineum, and oral cavity lesions. Pharmacologic measures, debridement of devitalized areas, and laser therapy were adopted. She was discharged from the hospital after 14 days. CASE 2: MMS, 64, with deep vein thrombosis and Acute Renal Failure (ARF). She presented with pharmacodermia and was in the hospital to treat mucositis and skin lesions. Ten days later the rashes flared and mucositis was aggravated. Pharmacologic measures, protocols for mucositis, and control of mucocutaneous lesions were adopted. She died after 8 days. CASE 3: GSS, 14, with skin, oral, and mucosa lesions was treated in the ICU. Immunoglobulin and corticosteroids were used for SJS. He was discharged after 14 days. SSJ and NET are severe events mediated by the immune system and triggered by drugs. Decision-making should be fast and based on first symptoms. Stevens-Johnson syndrome (SSJ) and a toxic epidermal necrolysis (NET) are mucocutaneous reactions to drugs. Three cases of pharmacodermia are presented here. CASE 1: AGSS, 13, with SSJ with face, chest, perineum, and oral cavity lesions. Pharmacologic measures, debridement of devitalized areas, and laser therapy were adopted. She was discharged from the hospital after 14 days. CASE 2: MMS, 64, with deep vein thrombosis and Acute Renal Failure (ARF). She presented with pharmacodermia and was in the hospital to treat mucositis and skin lesions. Ten days later the rashes flared and mucositis was aggravated. Pharmacologic measures, protocols for mucositis, and control of mucocutaneous lesions were adopted. She died after 8 days. CASE 3: GSS, 14, with skin, oral, and mucosa lesions was treated in the ICU. Immunoglobulin and corticosteroids were used for SJS. He was discharged after 14 days. SSJ and NET are severe events mediated by the immune system and triggered by drugs. Decision-making should be fast and based on first symptoms.

CHRONIC PARACOCCIDIOIDOMYCOSIS WITH ORAL MANIFESTATION: A CASE SERIES

Paracoccidioidomycosis (PCM) is a deep mycosis caused by Paracoccidioides brasiliensis or P. lutzii fungi, endemic in the male population of the rural zone of Brazil and Latin American countries. The presence of oral moriform stomatitis is a common finding in actively infected patients and can be the first sign of the disease. We report 7 cases of chronic PCM diagnosed with oral lesion incisional biopsies, discussing their clinical and histopathologic features. Most of the patients were male and presented with multiple oral lesions with lymph nodes involvement. The diagnosis was based on clinical signs (cough, dyspnea, weight loss, and presence of mucocutaneous lesions) and complementary exams (chest radiograph, analyses of lymph node aspirates, incisional biopsies, and fungi culture). The patients were mostly treated by azoles, sulfonamides, or amphotericin B. The prognosis depended on the stage of the disease. A description of the follow-up of the aforementioned cases is also made.

Association of microRNA 17 host gene variant (rs4284505) with susceptibility and severity of systemic lupus erythematosus.

ObjectiveMicroRNAs are large family clusters of small noncoding RNAs that implicated in genetic and epigenetic regulation of several immunological processes and pathways. As an epigenetic modifier, the microRNA 17‐92 cluster host gene (MIR17HG) has been shown to regulate the expression of genes involved in systemic lupus erythematosus (SLE) pathway. This study aimed to explore the association of MIR17HG (rs4284505; A>G) variant with SLE development and phenotype in a sample of the Eastern Mediterranean population.MethodsA total of 326 participants (163 patients with SLE and 163 healthy controls) were enrolled in this study. The different genotypes of the MIR17HG (rs4284505) variant were characterized using the TaqMan real‐time polymerase chain reaction technique. Association with the available clinical and laboratory data, including the systemic lupus erythematosus disease activity index (SLEDAI), was also executed.ResultsThe MIR17HG (rs4284505) variant showed a protective effect against developing SLE under heterozygote (A/G vs A/A; odds ratio [OR] = 0.10, 95% confidence interval [CI] = 0.05‐0.20, P < 0.001) and dominant (A/G+G/G vs A/A; OR = 0.39, 95% CI = 0.25‐0.61, P < .001) models. This association was consistent even after SLE stratified by lupus nephritis. In contrast, rs4284505 (G/G) genotype conferred increased susceptibility to SLE (G/G vs A/A+A/G; OR = 2.15, 95% CI = 1.31‐3.53, P = .002). Moreover, the rs4284505 variant showed a statistically significant association with mucocutaneous lesions and SLEDAI scores (all P < .05).ConclusionThis study is the first one to explore that the MIR17HG rs4284505 is associated with SLE risk; (A/G) genotype conferred a protective effect, while the (G/G) genotype showed increased susceptibility to SLE and association with the disease severity in the study population.

Infection-Induced Porcine Ex Vivo Corneal Wound Model to Study the Efficacy of Herpes Simplex Virus-1 Entry and Replication Inhibitors.

Corneal infections by viruses and bacteria can result in ocular surface defects, ulcers, or wounds. Herpes simplex virus type-1 (HSV-1) is a human virus with global seroprevalence in the range of 60-90%. While the virus more commonly causes mucocutaneous lesions including ulcers on the face and mouth, it is also a leading cause of infection-associated blindness. In this chapter, we discuss an in-depth protocol required to evaluate corneal damage due to HSV-1 infection using porcine models of ex vivo infection. Our methods can be adapted to study similar infections caused by other viruses and bacteria.

Cowden syndrome is a risk factor for multiple neoplasm: a case report

BackgroundCowden’s syndrome is an autosomal dominant disease with variable penetrance, involving the tumor suppressor phosphatase and tension homolog gene, located on chromosome 10q22-23, responsible for cell proliferation, migration, and cellular apoptosis. Its clinical presentation encompasses mucocutaneous lesions, which are present around 99% of the time; macrocephaly; and cognitive impairment, and it precedes the appearance of neoplasms such as thyroid carcinoma, breast cancer, among others.In addition to these malformations, arteriovenous malformations of the brain and spine, endocrine abnormalities, skeletal defects, and cardiopulmonary lesions may also be found.The relevance of the case is due to the fact that, through a certain phenotype, the patient’s genotype can be inferred and thus followed up closely.Case representationThe clinical case concerns a 28-year-old Caucasian and Portuguese woman with palmar pits, macrocephaly, and cognitive impairment. She was diagnosed with papillary thyroid carcinoma at 22 years of age and proposed total thyroidectomy.At age 27, a pregnancy was diagnosed with a Breast Imaging-Reporting and Data System 2-rated breast lump. After the histological verification, it was concluded that it was a high metastatic breast sarcoma, opting for palliative mastectomy. A genetic evaluation confirmed alteration in the phosphatase and tension homolog gene, confirming Cowden’s syndrome. The patient died at age 29 due to neoplastic pathology.ConclusionThis report aims to alert to the clinical signs of this entity and the clinical supervision and follow-up of these patients. In order to prevent premature deaths and to improve patient’s quality of life, genetic diseases with cancer impact should be diagnosed as early as possible.

Comparison of Disseminated Histoplasmosis with and without Cutaneo-Mucous Lesions in Persons Living with HIV in French Guiana.

Introduction: Histoplasmosis is the main opportunistic infection and cause of death in HIV-infected persons living with HIV in French Guiana and probably in most of Latin America. The objective of the present study was to compare cutaneomucous histoplasmosis to non-cutaneomucous histoplasmosis in French Guiana. Methods: Between 1981 and 2014 AIDS-related disseminated histoplasmosis patients followed in the three hospitals of French Guiana were retrospectively studied. Only proven incident cases of histoplasmosis, either by pathology and/or mycological analysis, were considered. Mucocutaneous histoplasmosis was ascertained by a positive mucosal or cutaneous biopsy. Results: Thirty-one patients had mucocutaneous lesions, and 318 had no mucocutaneous lesions. Patients with cutaneomucous lesions were more likely to have had prior opportunistic infections (35.5%) than those who did not have cutaneomucous lesions (19.5%). They were more likely to be very severely immunocompromised (CD4 count < 50) (90.3% versus 62.8%) and less likely to have digestive signs (32.3% versus 74.1%) and superficial adenopathies (29% versus 50.2%) than those without cutaneomucous lesions. In terms of simple biological examinations, patients with cutaneomucous lesions had fewer signs of cholestasis. The diagnosis was significantly more likely to be performed by direct examination and pathology in those with cutaneomucous lesions than in those without such lesions. On the contrary, patients with cutaneomucous lesions were less likely to be diagnosed by fungal culture than those without cutaneomucous lesions. There was a greater but non-significant risk of early death in those with cutaneomucous lesions relative to those without (OR = 2.28 (95%CI = 0.83–5.7), p = 0.056. Conclusions: Mucocutaneous forms were associated with more profound immunosuppression and perhaps risk of early death. They are easily accessible for diagnosis.

Mucocutaneous Manifestations in HIV-Infected Patients and Their Relationship to CD4 Lymphocyte Counts.

Background More than 90% of human immunodeficiency virus- (HIV-) infected patients show at least one mucocutaneous manifestation during the course of their disease. The frequency, pattern, and associated factors of these complications vary among different populations. Objective This study was planned to evaluate the frequency of cutaneous presentations in HIV-infected patients and their association with the count of CD4 cells. Methods A cross-sectional study was conducted on eighty-four HIV-positive patients, who attended the Behavior Consultation Center of Arak University of Medical Sciences. All subjects had a complete physical examination by an expert dermatologist. Further diagnostic procedures were performed, if necessary. Counts of CD4 were determined using flow cytometry. Results From 84 patients who enrolled in this study, 95.2% manifested at least one type of mucocutaneous lesions. The most common presentation was xerosis, followed by seborrheic dermatitis, herpes simplex, and oral candidiasis. Oral candidiasis and furuncle were significantly associated with decrease in CD4 cell counts. Conclusions Cutaneous manifestations are common in HIV-positive patients, some of which (oral candidiasis and furuncle) could be applicable as useful clinical indicators to predict the immune status of the patients. Therefore, regular skin examinations are recommended as routine HIV-infected patients' healthcare programs.

Crohn’s disease presenting with atypical mucocutaneous lesions in an 11 year old boy

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AN UNUSUAL CASE OF EXTRAGINGIVAL PYOGENIC GRANULOMA ASSOCIATED WITH A FENESTRATION DEFECT

&#x0D; &#x0D; &#x0D; Pyogenic granulomas are relatively common benign mucocutaneous lesions found in the oral cavity or extra orally; The first case was reported in 1844 by Hullihen and the term “pyogenic granuloma” or “granuloma pyogenicum” was coined only in 1904 by Hartzell. It is a reactive tumor like lesion which arises in response to various stimuli such as chronic low grade irritation[1], trauma and hormonal imbalance[2]. It's an inflammatory hyperplasia commonly seen in the oral cavity caused due to chronic irritation and trauma. In this case report we present a case of pyogenic granuloma associated with gingival/bony fenestration caused due to chronic irritation by exposed root tip.&#x0D; &#x0D; &#x0D;

Laryngeal zoster: two esoteric cases

&lt;p class="abstract"&gt;Herpes zoster is a neurocutaneous disease resulting from the reactivation of varicella-zoster virus in dorsal sensory or cranial nerve ganglia. A thorough knowledge of laryngeal zoster is important to diagnose Zoster sine herpete. Case I shows polyneuritic involvement. Case II shows mononeuritic presentation. The clinical picture of laryngeal zoster varies from mucocutaneous lesions and paralysis to that mimicking malignancy leading to missed diagnoses.&lt;/p&gt;

Kawasaki disease: About a case in Senegal

Kawasaki disease is an acute multisystemic vasculitis. We report the case of a 10-month-old boy received for a fever of 38.7° Celsius persisting on usual antipyretics for 10 days and bilateral conjunctivitis. The patient had bilateral serous rhinorrhea, polymorphic rash with diffuse perineal erythema, bilateral angular cheilitis, erythematous throat, plus perioral, periorbital and trunk desquamative lesions. There was microcytic hypochromic anemia at 9.5g/dL, thrombocytosis at 760x103/mm3, hyperleukocytosis at 28.27x103/mm3, positive C-reactive protein at 58 mg/L and an elevated sedimentation rate at 88 mm at the second hour. Aspartate amino transferase acid (AST) was elevated to 30 IU/L and alanine amino transferase acid (ALT) to 45 IU/L. Gamma glutamate transferase (γ-GT) was elevated at 488mg/dl. Cytobacteriological examination of the urine indicated aseptic pyuria. Cardiac Doppler ultrasonography showed low-grade pericarditis without coronary involvement. In the presence of prolonged fever &gt; 5 days: bilateral conjunctivitis, oropharyngeal involvement, polymorphic rash, CRP &gt;30mg/dL, VS &gt;40mm/h, thrombocytosis, elevated transaminases and gamma GT, aseptic pyuria and pericarditis, we retained the diagnosis of Kawasaki disease in its incomplete form. The patient had been treated with acetylsalicylic acid 50mg/kg/24h. The evolution was favorable with stable apyrexia, regression of mucocutaneous lesions and normalization of cardiac ultrasound.

Syphilis: A Contemporary Clinicopathologic Assessment.

Syphilis is a sexually transmitted disease caused by the spirochetal bacterium Treponema pallidum that has been of public health concern for centuries. In the United States, it is currently a reportable disease and one which is recently generating increasing case numbers especially in at risk populations of immune deficiency and men who have sex with men. The present series examines biopsies from 13 patients collected over a 12-year period from a general hospital network in north suburban Cook County, Illinois. There were 13 patients (11 male: 2 female) with varied presentations, including primary ulcerated anogenital chancres, mucosal lesions, peculiar rashes, and alopecia. The reason(s) for biopsy were not clear from the clinical record, as a clinical consideration of syphilis was recorded in only 3 cases. Histologic examination of the mucocutaneous lesions encompassed a spectrum of findings including ulceration, psoriasiform hyperplasia, intense mixed band-like inflammation at the dermal-epidermal junction with a prominent plasma cell component. The contemporary availability of an effective immunostain is a valuable diagnostic adjunct. The organisms generally parallel the intensity of the inflammatory infiltrate but the distribution may vary and rarely, organisms may be absent despite serologic confirmation. Previous corkscrew morphology of the organism described ultrastructurally is reflected in the immunostained representation. Although the diagnosis of syphilis remains a clinical one in most cases, some patients will have unusual presentations and biopsies will be done. The awareness of the pathologist will facilitate prompt and effective treatment.