ORAL MANIFESTATION OF SYPHILIS: AN UNUSUAL PRESENTATION OF TERTIARY SYPHILIS

A 48-year-old female patient, a smoker and alcohol user, presented a painful ulcer lesion with a central crusty, bleeding-to-the-touch growth of 2.5 cm on her lower lip for 40 days. Also, skin lesions looked like eczematous dermatoses, and lymph nodes were soft and sore. Exfoliative cytology excluded malignancy, immunophenotype was negative, and histopathology showed formation of granulomas and vascular proliferations, suggesting Spirochaetas presence. Laboratorial examinations showed human hepesvirus 8/Epstein-Barr virus/cytomegalovirus (−), HIV 1-2 (−), Venereal Disease Research Laboratory (+), rapid plasma reagin test reactive at 1:64, and fluorescent treponemal antibody absorption (+). The final diagnosis was tertiary syphilis, and the lesion on the lower lip was characterized as syphilitic gumma. The patient was referred to gynecology service. The treatment was based on intramuscular benzathine penicillin, divided in 3 weekly doses. After a small improvement of the lesion, another Venereal Disease Research Laboratory serology was performed without any changes. The patient is in good health and continues under follow-up.