Sheeza Basharatover 2 years ago

Syphilis

A 55 year old male with extensive smoking and alcohol use was referred for malignancy evaluation with an ulcerative mass creating a tongue cleft, and a positron emission tomography scan suggestive for malignancy. Biopsy results demonstrated no carcinoma but histology demonstrated granulomatous inflammation. The great Imitator “Syphilis” may present with a myriad of oral manifestations in the primary, secondary, and tertiary stages, and may be confused with malignancy. This image shows persistent tongue cleft after antibiotic therapy. The patient had a significant history of alcohol and tobacco abuse, a painful ulcerative tongue lesion, lymphadenopathy, and a positive positron emission tomography scan, which is considered a malignancy as the top differential even after 2 negative biopsies for malignancy. To our knowledge, this is the first case to be reported in which tertiary syphilis has created a tongue cleft in a patient. It is vital to have a wide differential in the setting of granulomatous inflammation seen on histopathology. Because syphilis presents in a myriad of ways, this disease poses a diagnostic challenge and will oftentimes take an extensive workup to lead to the diagnosis. Therefore, it is critical for clinicians to consider syphilis in the differential for ulcerative oral lesions and to perform serological tests in questionable cases.