RESUMO
Background: Syphilis is an infectious disease caused by the spirochete Treponema pallidum, transmitted mainly by direct contact with the lesion. Primary syphilis usually presents with a chancre at the site of infection, which is highly contagious and resolves without treatment. The aim of this article is to illustrate an unusual location of a syphilitic chancre, in order to consider this diagnosis within the approach to patients with oral ulcers. Clinical case: a 30-year-old man who presented a dermatosis located in the left labial commissure, characterized by a painless ulcer of 1 cm in diameter of 20 days of evolution. The patient has a history of HIV/AIDS. A punch biopsy of the dermatosis was performed, with a histopathological report compatible with syphilitic chancre and a negative VDRL result. He was treated with penicillin G benzathine showing improvement. Conclusions: Primary syphilis is characterized by the development of the syphilitic chancre, which is the first manifestation of syphilis in up to 60% of cases. Extragenital presentation is rare, with only 12-14% of all cases, and of these between 40-70% occur in the mouth, being the lips the most frequent location. Oral manifestations can represent a diagnostic challenge due to its wide spectrum of clinical presentations.
Introducción: la sífilis es una enfermedad infecciosa causada por la espiroqueta Treponema pallidum, transmitida principalmente por contacto directo con la lesión. La sífilis primaria generalmente se presenta con un chancro en el sitio de la infección, el cual es altamente contagioso y se resuelve sin tratamiento. El objetivo de este trabajo es ilustrar una localización poco común de un chancro sifilítico, ya que conocer la existencia de presentaciones poco frecuentes permitirá favorecer su sospecha al abordar las causas de úlceras orales. Caso o casos clínicos: hombre de 30 años de edad, el cual presenta una dermatosis localizada en la comisura labial izquierda, caracterizada por una úlcera no dolorosa de 1 cm de diámetro de 20 días de evolución. El paciente tiene antecedente de VIH/SIDA. Se realizó biopsia en sacabocados de la dermatosis, siendo el informe histopatológico compatible con chancro sifilítico y resultado de VDRL negativo. Fue tratado con penicilina G benzatínica, con lo que presentó mejoría. Conclusiones: la sífilis primaria se caracteriza por la aparición del chancro sifilítico, el cual es la primera manifestación de la sífilis hasta en el 60% de los casos. La presentación extragenital es rara, con solo un 12-14% de todos los casos y, de estos, entre un 40-70 % se presentan en la boca, siendo los labios la localización más frecuente. Las manifestaciones orales pueden representar un desafío diagnóstico debido a su amplio espectro de presentaciones clínicas.
Assuntos
Cancro , Dermatopatias , Sífilis , Masculino , Humanos , Adulto , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Cancro/diagnóstico , Cancro/tratamento farmacológico , Penicilina G Benzatina/uso terapêutico , BocaAssuntos
Cancro/diagnóstico , Linfadenopatia/diagnóstico por imagem , Doenças Retais/diagnóstico , Úlcera/diagnóstico , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Cancro/tratamento farmacológico , Cancro/patologia , Colonoscopia , Doxiciclina/uso terapêutico , Humanos , Linfadenopatia/tratamento farmacológico , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças Retais/tratamento farmacológico , Doenças Retais/patologia , Retratamento , Úlcera/tratamento farmacológico , Úlcera/patologiaRESUMO
Objective To analyze the reasons of misdiagnosis of primary syphilitic chancre and strengthen the understanding of atypical features of this disease. Methods A case series of twenty-seven challenging primary syphilis patients who were not immediately recognized as chancre was included in our study. The clinical data including the patients' age, sex, skin lesions, HIV status, syphilis serologic test results, treatment, and follow-up results were collected. Hematoxylin-eosin and immunohistochemistry staining of skin biopsy sections were reviewed. Results Four female cases with extragenital chancres presenting as erythema or erosive skin lesions on the nipple were misdiagnosed as Paget's disease or eczema. The disorder of missed or misdiagnosed male cases manifested as syphilitic balanitis or multiple chancres on the penis root and adjacent pubis rather than coronal sulcus or frenum. Patients with nonreactive nontreponemal tests at initial presentation were also easily missed or misdiagnosed. Conclusion Primary syphilis presenting as multiple lesions rather than a single chancre, at atypical locations, or with a nonreactive nontreponemal test result, tends to be missed or misdiagnosed.
Assuntos
Cancro , Sífilis , Cancro/diagnóstico , Feminino , Humanos , Masculino , Mamilos , Pele , Sífilis/diagnósticoAssuntos
Cancro/diagnóstico , Homossexualidade Masculina , Doenças Faríngeas/diagnóstico , Doenças Retais/diagnóstico , Treponema pallidum/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Cancro/tratamento farmacológico , Seguimentos , Humanos , Laringoscopia/métodos , Masculino , Doenças Faríngeas/tratamento farmacológico , Reação em Cadeia da Polimerase/métodos , Proctoscopia/métodos , Doenças Retais/tratamento farmacológico , Estudos de AmostragemAssuntos
Anti-Infecciosos/uso terapêutico , Doenças do Ânus/tratamento farmacológico , Doenças do Ânus/microbiologia , Doenças do Ânus/virologia , Cancro/diagnóstico , Cancro/tratamento farmacológico , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/tratamento farmacológico , Giardíase/diagnóstico , Giardíase/tratamento farmacológico , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Granuloma Inguinal/diagnóstico , Granuloma Inguinal/tratamento farmacológico , Herpes Genital/diagnóstico , Herpes Genital/tratamento farmacológico , Humanos , Sífilis Cutânea/diagnóstico , Sífilis Cutânea/tratamento farmacológicoRESUMO
In the differential diagnosis of patients with ulcers on the lips characteristics like the duration of the ulcer, number, size, depth, shape, base, margins, and distribution are considered. Such ulcers arise from many diseases particularly, viral and bacterial infections, malignancies can also be responsible. Classic syphilitic chancres are painless erosions settled on hard papule; these are evident in the genital area in more than 90% of patients. This study describes a case of a 38-year-old female patient presenting with a painful ulcer covering 3 quarters of the upper lip showing settlement on erythematous, edematous, and indurated plaque covered with hemorrhagic crusts. The aim of this study was to consider differences between the classic syphilitic chancre typically found in the genital region from extragenital chancres and to raise awareness of the possibility of primary syphilis when patients present with painful ulcers on the lip.
Assuntos
Cancro/diagnóstico , Cancro/microbiologia , Doenças Labiais/diagnóstico , Doenças Labiais/microbiologia , Adulto , Antibacterianos/uso terapêutico , Nádegas/microbiologia , Nádegas/patologia , Cancro/tratamento farmacológico , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Humanos , Doenças Labiais/tratamento farmacológico , Penicilina G/uso terapêutico , Comportamento Sexual , Sorodiagnóstico da Sífilis/métodos , Resultado do Tratamento , Treponema pallidum/imunologia , Treponema pallidum/isolamento & purificaçãoRESUMO
Secondary syphilis develops in approximately 25% of patients infected with the spirochete bacterium Treponema pallidum. It typically develops several weeks to several months after the primary infection, which is recognized by a painless chancre. Secondary syphilis is characterized by systemic symptoms, such as malaise and fever as well as a maculopapular rash involving the trunk and extremities including the palms and soles. Condyloma lata, which are raised, fleshy lesions, tend to develop at the site of the primary chancre. Diagnosis is achieved primarily through screening and confirmational serologic testing. Histologic findings seen in condyloma lata are largely non-specific. Therefore, a high index of suspicion should be maintained and immunohistochemical stains specific for T. pallidum should be utilized.
Assuntos
Doenças da Boca/diagnóstico , Doenças da Boca/microbiologia , Sífilis/diagnóstico , Adulto , Cancro/diagnóstico , Cancro/patologia , Humanos , Masculino , Doenças da Boca/patologia , Sífilis/patologiaRESUMO
Sexually transmitted diseases (STDs) continue to be a global epidemic with significant risk of morbidity/mortality for the fetus. STDs with prominent cutaneous findings including condylomata acuminata, genital herpes infections, and syphilis are reviewed. Important clinical cutaneous findings help aid early diagnosis and facilitate treatment. Condylomata acuminata have the potential of causing cervical cancer, anogenital cancer, and oropharyngeal cancer. Significant advances have been made in human papilloma virus vaccinations and treatment. Genital herpes infection can produce significant physical and emotional distress to the patient and significant potential harm to the fetus. Early clinical recognition of STDs and their appropriate management is critical.
Assuntos
Antibacterianos/uso terapêutico , Antineoplásicos/uso terapêutico , Antivirais/uso terapêutico , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/uso terapêutico , Infecções Sexualmente Transmissíveis/terapia , Neoplasias do Colo do Útero/prevenção & controle , Aciclovir/análogos & derivados , Aciclovir/uso terapêutico , Aminoquinolinas/uso terapêutico , Cancro/diagnóstico , Cancro/tratamento farmacológico , Cancro/epidemiologia , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/epidemiologia , Condiloma Acuminado/terapia , Feminino , Herpes Genital/tratamento farmacológico , Herpes Genital/epidemiologia , Humanos , Imiquimode , Infecções por Papillomavirus/epidemiologia , Penicilinas/uso terapêutico , Podofilotoxina/uso terapêutico , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/epidemiologia , Sífilis Cutânea/diagnóstico , Sífilis Cutânea/tratamento farmacológico , Sífilis Cutânea/epidemiologia , Valaciclovir , Valina/análogos & derivados , Valina/uso terapêuticoRESUMO
A 33-year-old man presented with a two-week history of an asymptomatic ulcer of the oropharynx and submandibular lymph nodes swelling. Laboratory examinations were normal, but serological tests revealed positivity for rapid plasma reagin, Treponema pallidum haemagglutination assay and anti-T. pallidum IgM antibodies. Since the patient denied any homosexual relationship, a biopsy of the lesion was performed, which confirmed primary syphilis. The patient received an intramuscular injection of Benzathine Penicillin G (2.4 MU) with complete resolution of the lesion. Extragenital chancres occur in at least 5% of patients with primary syphilis, and the oral mucosa is the most frequent location as a consequence of orogenital/oroanal contact with an infectious lesion. Because of their transient nature, these oral ulcerations are often underestimated by the patient or by any unsuspecting clinician. Health professionals should consider the recent sexual history of their patients and should be prepared to recognise oral and systemic manifestations of sexually transmitted infections.
Assuntos
Antibacterianos/uso terapêutico , Cancro/tratamento farmacológico , Penicilina G Benzatina/uso terapêutico , Adulto , Antibacterianos/administração & dosagem , Cancro/diagnóstico , Humanos , Imuno-Histoquímica , Injeções Intramusculares , Masculino , Orofaringe/microbiologia , Penicilina G Benzatina/administração & dosagem , Sorodiagnóstico da Sífilis , Resultado do TratamentoAssuntos
Cancro/microbiologia , Sífilis/microbiologia , Treponema pallidum/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Técnicas Bacteriológicas , Biópsia , Cancro/diagnóstico , Cancro/tratamento farmacológico , Antebraço , Homossexualidade Masculina , Humanos , Masculino , Penicilina G Benzatina/uso terapêutico , Valor Preditivo dos Testes , Fatores de Risco , Sífilis/complicações , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Resultado do Tratamento , Sexo sem ProteçãoAssuntos
Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Masculinos/diagnóstico , Úlceras Orais/diagnóstico , Úlcera/diagnóstico , Doenças Autoimunes/complicações , Doenças Autoimunes/diagnóstico , Biópsia , Carcinoma de Células Escamosas/diagnóstico , Cancro/diagnóstico , Diagnóstico Diferencial , Feminino , Doenças dos Genitais Femininos/etiologia , Doenças dos Genitais Femininos/terapia , Doenças dos Genitais Masculinos/etiologia , Doenças dos Genitais Masculinos/terapia , Herpes Simples/complicações , Herpes Simples/diagnóstico , Humanos , Masculino , Úlceras Orais/etiologia , Úlceras Orais/terapia , Recidiva , Infecções Sexualmente Transmissíveis/complicações , Infecções Sexualmente Transmissíveis/diagnóstico , Dermatopatias Infecciosas/complicações , Dermatopatias Infecciosas/diagnóstico , Neoplasias Cutâneas/diagnóstico , Estomatite Aftosa/diagnóstico , Estomatite Aftosa/etiologia , Estomatite Aftosa/terapia , Úlcera/etiologia , Úlcera/terapiaAssuntos
Balanite (Inflamação)/diagnóstico , Cancro/diagnóstico , Sífilis Cutânea/diagnóstico , Balanite (Inflamação)/patologia , Biópsia , Cancro/patologia , Diagnóstico Diferencial , Humanos , Linfonodos/patologia , Masculino , Necrose , Pele/patologia , Sorodiagnóstico da Sífilis , Sífilis Cutânea/patologia , Adulto JovemAssuntos
Cancro/diagnóstico , Erupções Liquenoides/patologia , Sífilis Cutânea/diagnóstico , Biópsia , Cancro/complicações , Cancro/microbiologia , Diagnóstico Diferencial , Humanos , Técnicas Imunoenzimáticas , Erupções Liquenoides/etiologia , Erupções Liquenoides/microbiologia , Masculino , Pessoa de Meia-Idade , Micoses/diagnóstico , Pescoço , Neoplasias Cutâneas/diagnóstico , Sorodiagnóstico da Sífilis , Sífilis Cutânea/complicações , Sífilis Cutânea/microbiologia , Treponema pallidum/imunologia , Treponema pallidum/isolamento & purificação , Tuberculose Cutânea/diagnósticoRESUMO
BACKGROUND: Known as "the great imitator," secondary syphilis may clinically manifest itself in myriad of ways, involving different organs (including the oral cavity), and mimicking, both clinically and histologically, several diseases, thereby making diagnosis a challenge for clinicians. CASE REPORT: We highlight an interesting case of a 45-year-old man on whose diagnosis of secondary syphilis was based on the presence of unusual oral lesions, consisting of a well delimited, raised, nonhomogeneous, and corrugated white plaque on the right buccal mucosa which mimicked, clinically and histologically, a "leukoplakia-like" plaque and several whitish oral mucous patches localized on the lower labial mucosa and the right lateral margin of the tongue. After the oral lesions, the patient developed a symmetric maculopapular cutaneous rash on the palms, soles, and the trunk of the body. Furthermore, during the anamnesis the patient stated an asymptomatic ulcerative lesion on the glans penis, which had appeared 7 months before the onset of the oral lesions and spontaneously disappeared after 2 weeks. The history of these genital and cutaneous lesions suggested performing serologic tests for syphilis, revealing strongly positive titers and leading us to making a diagnosis of secondary syphilis. CONCLUSION: This case is remarkable because it displays an unusual oral sign, associated with secondary syphilis; in fact, only occasionally does syphilis manifest itself with a "leukoplakia-like" plaque. Dentists should consider secondary syphilis in the differential diagnosis of white and/or ulcerative oral lesions, above all in at-risk patients, given the continuing rise of syphilis in western Europe.
Assuntos
Doenças da Boca/microbiologia , Sífilis/diagnóstico , Candidíase Bucal/diagnóstico , Cancro/diagnóstico , Diagnóstico Diferencial , Humanos , Leucoplasia Oral/diagnóstico , Doenças Labiais/microbiologia , Masculino , Pessoa de Meia-Idade , Doenças da Boca/diagnóstico , Doenças do Pênis/diagnóstico , Sífilis Cutânea/diagnóstico , Doenças da Língua/microbiologiaRESUMO
The high signal intensities in bilateral mesiotemporal lobes on T2-weighted images are typical findings of herpes encephalitis or paraneoplastic limbic encephalitis. We report a case of neurosyphilis with mesiotemporal involvement on MRI. Positive antibodies in the cerebrospinal fluid confirmed the diagnosis. The results suggest that neurosyphilis should be considered when MRI results indicate mesiotemporal abnormalities.
Assuntos
Imageamento por Ressonância Magnética/métodos , Neurossífilis/diagnóstico , Lobo Temporal/patologia , Adulto , Antibacterianos/administração & dosagem , Biópsia por Agulha , Cancro/diagnóstico , Cancro/patologia , Diagnóstico Diferencial , Encefalite por Herpes Simples/diagnóstico , Seguimentos , Humanos , Encefalite Límbica/diagnóstico , Masculino , Neurossífilis/tratamento farmacológico , Neurossífilis/patologia , Penicilinas/administração & dosagem , Doenças Raras , Língua/patologiaRESUMO
The prevalence of sexually transmitted diseases (STD) has risen in recent years [Brown AE, Sadler KE, Tomkins SE, McGarrigle CA, LaMontagne DS, Goldberg D, et al. Recent trends in HIV and other STIs in the United Kindom: data to the end of 2002. Sex Transm Infect 2004;80:159-66]. Homosexually active men have frequent intestinal and rectal symptoms due to sexually acquired gastrointestinal infections [Surawicz CM, Goodell SE, Quinn TC, Roberts PL, Corey L, Holmes KK, et al. Spectrum of rectal biopsy abnormalities in homosexual men with intestinal symptoms. Gastroenterology 1986;91:651-9]. The number of reported cases of primary syphilis is increasing especially among this group of people [Goh BT. Syphilis in adults. Sex Transm Infect 2005;81:448-52 ]. We herein describe a case of a young man with a primary syphilitic rectal localization mimicking rectal cancer.