Large stomatitis in a young woman
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IMAGES IN INFECTION
Large stomatitis in a young woman Shinya Hasegawa1 · Yasuaki Tagashira1 · Akane Takamatsu1 · Hitoshi Honda1 Received: 30 November 2019 / Accepted: 11 March 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abbreviations RPR Rapid plasma reagin TPLA Treponema pallidum Latex agglutination HIV Human immunodeficiency virus HSV Herpes simplex virus PCR Polymerase chain reaction A 29-year-old Japanese woman with no known past medical history came to our clinic with the main complaint of a circular stomatitis and cervical lymphadenopathy since 4 weeks. On examination, the patient had a painless, sharply demarcated, sublingual, and ulcerated lesion (Fig. 1). She was in the 22nd week of pregnancy and sexually active with multiple male partners. Laboratory data revealed elevated titer of RPR (28.2 R.U.) and TPLA (28930.3 T.U.). Serological tests for HIV and HSV were negative. We clinically diagnosed primary syphilis in pregnancy. The diagnosis was later confirmed by histopathological findings on Warthin–Starry staining (Fig. 1) and the detection of T. pallidum DNA in tissue by PCR. Syphilis is one of the most common sexually transmitted infections (STIs) with a wide variety of clinical manifestations. Chancre is considered to be a characteristic finding and develops 3–90 days after exposure [1, 2]. The classic chancre is painless and nontender on examination; spirochetal infiltration of cutaneous sensory nerves may explain this phenomenon. In heterosexuals, the chancre typically occurs on the upper lip in men and on the tongue in women [3]. The diagnosis of syphilis remains challenging, as T. pallidum is unable to be cultured in the laboratory unlike many other bacteria. Serological testing, such as reactive non-treponemal and treponemal tests, is the most common method for a “probable” diagnosis of syphilis. Additional * Shinya Hasegawa [email protected] 1
Division of Infectious Diseases, Department of Medicine, Tokyo Metropolitan Tama General Medical Center, 2‑8‑29, Musashidai, Fuchu‑City, Tokyo 183‑8524, Japan
testing, such as the direct visualization of T. pallidum by microscopy, or PCR for infected tissues may be needed to confirm the diagnosis [4]. Acknowledgements We thank Drs Daisuke Kobayashi and Takahiro Kiryu for providing the picture of the lesion and histopathological insights. Author contributions All authors treated the patient. YT, AT and HH provided critical revision of the report. All authors reviewed and approved the final version. Funding None.
Compliance with ethical standards Conflict of interest On behalf of all authors, the corresponding author states that there is no conflict of interest. Ethical standards This study has been approved by the appropriate ethics committee and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The patient gave informed consent prior to writing this article. Ethical approval This study was approved by the institutional
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