An extraordinary case of syphilis presenting with a labial ulcer

Abstract

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.

Figure 1

Extragenital chancre on the upper lip.

Figure 2

Typical extragenital chancre on the intergluteal cleft.

Figure 3

An ulcerated area rich in lymphocytes and plasma cells with inflammation, vascular proliferation and swelling of endothelial cells in vascular structures (hematoxylin-eosin staining; x20 magnification. Plasma cell (white arrow), swelling of endothelial cells in vascular structures (Black arrow).

Figure 4

The patient’s ulcer regressed completely after treatment