A Lip Mass Revealing Syphilis: A Case Report With a Review of the Literature.

BACKGROUND

Syphilis is a chronic systemic infection caused by Treponema pallidum and is well known for its wide spectrum of clinical presentations. Oral manifestations are uncommon and often mimic benign or reactive lesions, making diagnosis challenging, particularly in the absence of overt systemic symptoms.

CASE PRESENTATION: We report a case of a 26-year-old male who presented with a nonpainful swelling of the lower lip that had persisted for 2 months, with a differential diagnosis including both reactive and neoplastic processes, and underwent a biopsy for definitive diagnosis. Histopathological examination demonstrated ulcerated oral mucosa with psoriasiform epithelial hyperplasia, neutrophilic transmigration, and a dense chronic inflammatory infiltrate rich in plasma cells. Immunohistochemical staining highlighted Treponema pallidum organisms within the lesional tissue, and serologic testing was positive, confirming the diagnosis of syphilis. At follow-up, the patient developed additional oral ulcers and a maculopapular rash involving the palms, soles, and genitalia, consistent with systemic disease, and was referred for medical management.

CONCLUSION

This case underscores the importance of considering syphilis in the differential diagnosis of atypical oral lesions. Early recognition by dental practitioners, supported by histopathological evaluation, immunohistochemistry, and serologic testing, is essential for timely diagnosis, appropriate referral, and prevention of disease progression and transmission.