The n e w e ng l a n d j o u r na l of m e dic i n e

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Syphilitic Chancre of the Tongue

A B

A
41-year-old man presented with a 6-week history of a painful, Konrad Staines, B.Ch.D.
nonhealing lesion on the dorsum of his tongue. Examination revealed an Philip Sloan, B.D.S., Ph.D.
ulcer with a raised, indurated margin (Panel A). Malignancy and other infec- Newcastle Dental School
tions were considered in the differential diagnosis. There was no lymphadenopathy Newcastle upon Tyne, United Kingdom
on examination. A chronic inflammatory infiltrate with mature plasma cells and a
granulomatous component was evident on incisional biopsy. Immunohistochemi-
cal staining for Treponema pallidum identified spirochetes in the granulation tissue
overlying the ulcer, as well as in the walls and lumen of the capillaries at its margin
(Panel B, arrows). A strongly positive treponemal antibody absorption test and par-
ticle agglutination assay (titer ≥1:1280) and a second-line enzyme immunoassay
confirmed these findings. The tongue ulcer was diagnosed as a primary syphilitic
chancre. The results of screening tests for the human immunodeficiency virus,
chlamydia, and Neisseria gonorrhoeae were negative, and the patient was referred to
public health officials for sexual-contact tracing. Standard treatment with a single
intramuscular injection of benzathine penicillin G resulted in rapid pain relief and
complete resolution of the chancre over a 3-week period.
Copyright © 2011 Massachusetts Medical Society.

n engl j med 365;5 nejm.org august 4, 2011 e11

The New England Journal of Medicine
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