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Case Reports
. 2020 Feb 24;12(2):e7086.
doi: 10.7759/cureus.7086.

Primary Syphilis Presenting As a Chronic Lip Ulcer

Claire Porterfield  1 , David Brodell  2 , Lindsey Dolohanty  2 , Glynis Scott  3
Affiliations
Case Reports

Primary Syphilis Presenting As a Chronic Lip Ulcer

Claire Porterfield et al. Cureus. .

Abstract

Syphilis is usually a sexually transmitted infection caused by the spirochete Treponema pallidum. Primary syphilis classically presents as a painless, ulcerated lesion on the genitals. However, the primary lesion is not restricted to this site and appears wherever the spirochete enters through the skin. The symptomatology and appearance of the primary lesion can also vary. We present a case of a 59-year-old man with a primary syphilitic chancre of the lower lip. The patient was referred to the dermatology clinic by their primary care provider after the ulceration failed to heal with antibiotic therapy. A biopsy of the lesion was taken at this time; the diagnosis of syphilis was then made by histologic examination and immunohistochemical staining. Subsequent serologic tests were also positive. Upon prompting, the patient did report a history of sexually transmitted disease but not of syphilis specifically. The patient was treated with penicillin, and there was clinical improvement of the lesion at the follow-up visit.

Keywords: biopsy; chancre; chronic ulcer; cutaneous; histology; oral syphilis; primary syphilis; skin; syphilis; treponema pallidum.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Syphilitic chancre presenting as hemorrhagic, crusted plaque on the right cutaneous lip with associated edema.
Figure 2
Figure 2. Hematoxylin and eosin staining of a skin biopsy at 10x magnification.
The skin is oriented with the surface at the top of the image. There is a diffuse, dense inflammatory cell infiltrate that fills the upper dermis. Within this inflammatory infiltrate are abundant plasma cells (arrows), which are discernible by their hyperchromatic (dark purple) nuclei.
Figure 3
Figure 3. Immunohistochemical stain for Treponema pallidum (10x magnification).
The skin is oriented with the surface at the top of the image. Within the epidermis, the stain highlights thin Treponema pallidum organisms in pink (arrows).
Figure 4
Figure 4. Resolving syphilitic chancre of the left cutaneous lip, four weeks after treatment.
See this image and copyright information in PMC

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