PMC5328931_01
(A) The lip lesion at the initial presentation in September 2015. Crusted impetiginous lesion with red base. (B) Syphilitic primary chancre on the inside of the left lower lip with red base and indurated margin. (C and D) Hematoxylin & Eosin staining of the lesional biopsies with lymphohistiocytic band-like infiltrate present in the upper part of the dermis that also extends around blood vessels. There is a mixed inflammatory cell infiltrate; however, the plasma cell population is not overly impressive. There is exocytosis of inflammatory cells through the epithelium. (E and F) Immunohistochemistry of the oral biopsy specimens showing slender stained (brown) spirochetes.
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It also had a white reticular appearance that could not be wiped away with a Q-tip (Fig. 1A and B). There was an irregular, island-shaped, raised, red lesion, 4 cm in diameter (Fig. 1B) with superficial ulceration and weeping on the buccal mucosa adjacent to his lower incisor tooth that was slightly painful to palpation and bled slightly to touch. Histopathological examination showed epithelial hyperplasia with mixed chronic inflammation and exocytosis of inflammatory cells through the epithelium, as well as microabscesses in the superficial dermis (Fig. 1C,D). As shown in Fig. 1E and F, abundant spirochetes stained strongly suggesting infection with T. pallidum.