Persistent oral ulceration and enlarged necrotic lymph nodes: a clinicopathological conference

Syphilis is an infectious disease caused by the anaerobic spirochaete Treponema pallidum. Syphilis is known to present with oral manifestations, namely transient ulcers in its primary form, snail-track ulcers in the secondary form and gumma formation in its tertiary form. The patient was presented to the oral and maxillofacial clinic with persistent oral ulceration in the left buccal mucosa, with rolled margins and rapid onset cervical lymphadenopathy therefore mimicking the appearance of oral squamous cell carcinoma. Biopsies of the oral ulceration and of the lymph nodes revealed no malignancy, but features consistent with an infectious process. This case report highlights the diagnostic challenges with the diagnosis of oral syphilis. It also discusses the laboratory tests used to finalise a diagnosis of syphilis, and aims to raise awareness of potential differential diagnosis.