Dental abscess as an initial presentation of tertiary syphilis: A case report

Abstract

Recognize syphilis as a re-emerging disease, especially in the presence of HIV. Syphilis, caused by the sexually transmitted spirochete Treponema pallidum, often occurs as coinfection in HIV-infected patients, and its prevalence has increased in the United States. We report a case of oral gummata presenting as a dental abscess in an HIVinfected 25-year-old MSM with no prior history of syphilis. The patient's rapid plasma reagin was positive at 1:512 dilution with positive confirmatory fluorescent treponemal antibody absorption test. Surgical exploration of the suspected abscess identified a 5-cm ulcerated mass eroding into the right maxillary sinus. Tissue gram stain and culture of the mass revealed only mixed oral flora. Pathology revealed acute and chronic inflammatory granulation tissue, and the Warthin-Starry stain identified rare microorganisms, suspicious for spirochetes. Our patient was treated for tertiary syphilis with intramuscular benzathine penicillin G injections weekly for 3 doses. At 1-month follow up, the patient was symptom-free.