Molly Housley Smith1, Richard J Vargo2, Elizabeth Ann Bilodeau3, K Mark Anderson4, Anna Trzcinska5, Carleigh R Canterbury6, John E Fantasia7, Yeshwant B Rawal8. 1. Division of Oral and Maxillofacial Pathology, University of Kentucky College of Dentistry, 800 Rose Street, Rm. 530, Lexington, KY, 40536, USA. molly.housley.smith@gmail.com. 2. Oral and Maxillofacial Pathology Specialty Care Unit, A.T. Still University-Missouri School of Dentistry & Oral Health, St. Louis, MO, USA. 3. Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, G-135 Salk Hall, 3501 Terrace St., Pittsburgh, PA, USA. 4. Department of Diagnostic Sciences, The University of Tennessee College of Dentistry, Memphis, TN, USA. 5. Head and Neck Pathology Fellow, Department of Pathology, The University of Chicago, Chicago, IL, USA. 6. Division of Oral and Maxillofacial Pathology, Columbia University Medical Center, New York, NY, USA. 7. Department of Dental Medicine, Division of Oral and Maxillofacial Pathology, Long Island Jewish Medical Center, Zucker School of Medicine At Hofstra Northwell Health, New Hyde Park, NY, USA. 8. Department of Surgical Sciences, Marquette University School of Dentistry, Milwaukee, WI, USA.
Abstract
BACKGROUND: Syphilis is a sexually-transmitted infectious disease caused by Treponema pallidum. Cases of primary and secondary syphilis are on the rise in the United States, with a 14.4% increase in new cases noted from 2017 to 2018 and an escalation of 71% between the years 2014 and 2018. Fulfilling its nickname of "the great imitator," oral manifestations of syphilis may mimic a variety of infectious, neoplastic, or immune-mediated processes, both clinically and histopathologically. This large spectrum of appearances can create a diagnostic challenge to the clinician and/or pathologist, leading to delay in diagnosis or misdiagnosis. METHODS: A database of oral syphilis cases was created from archives at the University of Kentucky, University of Pittsburgh, LIJMC, Columbia University MC, and University of Tennessee. The age, sex, race, location, duration, and clinical description were recorded. Cases without positive reaction upon immunohistochemistry or serologic tests were excluded. RESULTS: We identified 19 new cases of oral syphilis (17 males, one female, and one case unknown sex) and described the clinical and histopathological features of this re-emerging and potentially fatal disease. All cases demonstrated dense lymphoplasmacytic inflammation, often with inflammatory exocytosis or ulceration at the surface, and perivascular inflammation. CONCLUSIONS: Early recognition of the histopathologic and clinical manifestations of oral syphilis is imperative for prompt diagnosis, improved patient outcomes, and disease prevention.
BACKGROUND: Syphilis is a sexually-transmitted infectious disease caused by Treponema pallidum. Cases of primary and secondary syphilis are on the rise in the United States, with a 14.4% increase in new cases noted from 2017 to 2018 and an escalation of 71% between the years 2014 and 2018. Fulfilling its nickname of "the great imitator," oral manifestations of syphilis may mimic a variety of infectious, neoplastic, or immune-mediated processes, both clinically and histopathologically. This large spectrum of appearances can create a diagnostic challenge to the clinician and/or pathologist, leading to delay in diagnosis or misdiagnosis. METHODS: A database of oral syphilis cases was created from archives at the University of Kentucky, University of Pittsburgh, LIJMC, Columbia University MC, and University of Tennessee. The age, sex, race, location, duration, and clinical description were recorded. Cases without positive reaction upon immunohistochemistry or serologic tests were excluded. RESULTS: We identified 19 new cases of oral syphilis (17 males, one female, and one case unknown sex) and described the clinical and histopathological features of this re-emerging and potentially fatal disease. All cases demonstrated dense lymphoplasmacytic inflammation, often with inflammatory exocytosis or ulceration at the surface, and perivascular inflammation. CONCLUSIONS: Early recognition of the histopathologic and clinical manifestations of oral syphilis is imperative for prompt diagnosis, improved patient outcomes, and disease prevention.
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