Oropharyngeal Syphilis: Imaging and Pathologic Findings in Two Patients

Ripoll, Enric; Montironi, Carla; Alós, Llúcia; Pujol, Teresa; Berenguer, Joan; Oleaga, Laura

doi:10.1007/s12105-016-0758-x

Cited by 7 publications

(19 citation statements)

References 18 publications

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“…Here we presented a case of a young MSM with cervical lymphadenopathy, pulmonary nodule, and periportal lymph node, who was diagnosed with secondary syphilis. Reports on luetic cervical lymphadenopathy and oropharyngeal syphilis are increasing, possibly due to the prevalence of oral sex among MSM, although not all references mention sexual history in detail [ 5 – 8 ], and patients may deny a history of oral sex [ 9 , 10 ]. Cervical lymphadenopathy is commonly associated with tonsillitis [ 4 , 8 , 11 ] and oropharyngeal mucosal lesions (ulcers in the lip [ 12 , 13 ], oral mucosa [ 13 ], tongue [ 12 ], and tonsils [ 8 , 11 ]).…”

Section: Discussionmentioning

confidence: 99%

“…Differential diagnosis of syphilitic lymphadenopathy based on imaging is often confusing. MRI shows homogenous and high signal intensity on T1-weighted images [ 8 , 9 ]. Diffusion MRI, as in our case, and 18 F-fluorodeoxyglucose positron emission tomography-computed tomography [ 4 , 5 , 14 ] are both useful for screening and qualitative evaluation of malignancy, but cannot always distinguish inflammation from malignancy.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, in one case report, standardized uptake values of fluorodeoxyglucose in syphilitic pulmonary nodules ranged from 4.37 to 5.59, suggesting malignancy [ 14 ]. Cystic changes resembling central necrosis may be observed in luetic lymph nodes [ 8 ]. Thus, large cervical lymph nodes and disseminated lymphadenopathy due to secondary syphilis can mimic multiple metastases of cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Histopathological examinations are performed to rule out malignancy. In luetic tissues, plasma cell-rich inflammation is characteristic, regardless of the site of biopsy (e.g., tongue [ 18 ], palatine [ 18 ], tonsils [ 11 , 18 ], cervical lymph nodes [ 4 , 8 , 11 , 19 ], lung nodules [ 14 , 16 ], skin [ 16 , 18 ]). Fibrosis is observed in lung nodules [ 14 ] and the periphery of the swollen lymph nodes (“capsular/parcel fibrosis”) [ 8 , 10 , 11 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…In luetic tissues, plasma cell-rich inflammation is characteristic, regardless of the site of biopsy (e.g., tongue [ 18 ], palatine [ 18 ], tonsils [ 11 , 18 ], cervical lymph nodes [ 4 , 8 , 11 , 19 ], lung nodules [ 14 , 16 ], skin [ 16 , 18 ]). Fibrosis is observed in lung nodules [ 14 ] and the periphery of the swollen lymph nodes (“capsular/parcel fibrosis”) [ 8 , 10 , 11 , 19 ]. Perivascular inflammation [ 6 , 8 , 12 , 19 ], occlusion vasculitis [ 8 , 19 ], multinucleated giant cells [ 8 , 19 ], and granuloma formation [ 8 , 10 ] can also be seen in various biopsy samples.…”

Section: Discussionmentioning

confidence: 99%

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Secondary Syphilis with Tonsillar and Cervical Lymphadenopathy and a Pulmonary Lesion Mimicking Malignant Lymphoma

et al. 2018

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Patient: Male, 27Final Diagnosis: Secondary syphilisSymptoms: Fever • loss of appetite • neck mass • night sweats • weight lossMedication: Oral amoxicillinClinical Procedure: Lymph node biopsySpecialty: Infectious DiseasesObjective:Challenging differential diagnosisBackground:Syphilis is a sexually transmitted disease caused by the pathogen Treponema pallidum. Prevalence continues to rise, especially among men who have sex with men (MSM). Due to changes in patterns of sexual activity, manifestations of the disease are highly variable.Case Report:A 27-year-old male visited the hospital for a low-grade fever and tender 5-cm mass in the right side of his neck. His right tonsil was swollen and covered with a white coating. Levofloxacin was prescribed, but ineffective. The patient’s levels of liver function enzymes increased gradually. Systemic magnetic resonance imaging (MRI) revealed bilateral cervical lymphadenopathy with right predominance, a right pulmonary nodule, and a periportal lymph node, suggestive of malignant lymphoma. However, a biopsy of the right cervical lymph node showed nonspecific inflammation. Preoperative rapid plasma reagin (RPR) and T. pallidum latex agglutination (TPLA) tests were positive. The patient was MSM and reported oral sex with many sexual partners. A diagnosis of secondary syphilis was made. Oral amoxicillin was effective, and all symptoms other than periportal lymph node resolved.Conclusions:Tonsillitis, cervical lymphadenopathy, and lung lesions can be manifestations of secondary syphilis. A detailed history, pathology, and serology are crucial for diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Secondary Syphilis with Tonsillar and Cervical Lymphadenopathy and a Pulmonary Lesion Mimicking Malignant Lymphoma

et al. 2018

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Syphilis resembling human papilloma virus associated oropharyngeal cancer: case report and literature review of recent incidence trends

et al. 2022

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Background The yearly incidence of syphilis has risen markedly in Japan and worldwide. There has also been an increased incidence of human papilloma virus associated oropharyngeal cancer, which presents with clinical features similar to those of syphilis. Objective A case of syphilis with clinical manifestation resembling that of human papilloma virus associated oropharyngeal cancer is reported, along with a literature review of similar cases. Methods Clinical case reports and review of previous literature. Conclusion Syphilis may cause irregular mucosal lesions of the oropharynx and cystic lymphadenopathy. It is difficult to diagnose syphilis only by examining pathological specimens, without clinical information such as Treponema pallidum antibody findings. It is necessary to correctly understand the characteristics of syphilis and human papilloma virus associated oropharyngeal cancer to ensure prompt diagnosis and treatment.

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Oral syphilis - the great imitator: a series of six cases

Maloney,

Healy

2024

Br Dent J

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Syphilis is an infectious disease which can present with multitudinous mucocutaneous manifestations. Often referred to as the ‘great mimicker', syphilis can present with non-specific symptoms and has a tropism for various organ systems. The oral cavity has been identified as a site commonly affected in the early stages of syphilis infection. Identification of the diverse presentations seen across the different stages of syphilis infection can assist in early diagnosis and treatment for this cohort of patients. Despite accurate diagnostic tools and the susceptibility of the infection to standard antimicrobial therapy, syphilis infections continue to rise worldwide.We present the clinical features and management of six cases of oral syphilis who presented to our unit. One case presented in 2008, but the other five cases presented between 2016 and 2023, reflecting the increasing incidence of syphilis infection. Five cases presented in the secondary stage of the infection while one presented with a primary infection in the form of a single chancre.The documented cases demonstrate the non-specific and variable clinical features of oral syphilis and highlight the importance of awareness in the dental profession of these manifestations. Dentists have an important role to play in recognising the disease and arranging appropriate testing for early intervention. This will not only reduce the incidence of the devastating consequences of tertiary infections but will also result in reduced spread of the disease.

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Oropharyngeal Syphilis: Imaging and Pathologic Findings in Two Patients

Cited by 7 publications

References 18 publications

Secondary Syphilis with Tonsillar and Cervical Lymphadenopathy and a Pulmonary Lesion Mimicking Malignant Lymphoma

Secondary Syphilis with Tonsillar and Cervical Lymphadenopathy and a Pulmonary Lesion Mimicking Malignant Lymphoma

Syphilis resembling human papilloma virus associated oropharyngeal cancer: case report and literature review of recent incidence trends

Oral syphilis - the great imitator: a series of six cases

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