Figure 2 The ulcer on the lower lip disappeared after
treatment.
Diagnosis of syphilis remains an intractable problem to clinicians
because of its multiple features in morphology. The majority of chancres
locate in the genital area. A chancre is a painless, clean, solitary,
and indurated erosion in general. Nevertheless, the symptoms and
appearances of primary lesions may vary, such as in other sites, with
disparate size, amount, depth, shape, or manifest as mucous
patches2-3. Besides genitals, the rectum, anus, oral
cavity, face, eyes, and fingers are involved4.
Extragenital chancres cover about 5%~14% of the
cases5. The most common region is oral cavity. One
article points out that the tongue is the most affected site with
solitary location of oral primary syphilis6. However,
it is widely believed that lips are the usual location infected by
orogenital, oroanal contact or kissing. No matter in heterosexuals or in
MSM, oral sex is prevailing. It is reported that the upper lip is the
most common site among men, while the lower lip is among women possibly
because of fellatio and cunnilingus7. But our patient
was an exception. Whether it associates with his personal habits or not
is unknown.
In addition, syphilis is well known as a notorious imitator of various
diseases, the characteristics of
which are diverse. The chancre of the lips could mimic some infectious
diseases, such as herpes simplex, leishmania, tuberculosis, ulcers
caused by Epstein Barr virus or cytomegalovirus; and some non-infectious
diseases, just like fixed drug eruption, lichen planus, plasma cell
cheilitis, squamous cell carcinoma, Behcet disease, and
trauma3. When a chancre occurs in the lips or in other
regions except genitals, it is difficult to diagnose accurately and
without delay.
This case highlights that complete dermatological examination and
laboratory inspection are crucial to making an appropriate diagnosis
particularly when the initial treatment is ineffective.
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case report and a review of the literature of the most common
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10.1097/DAD.0000000000001659
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AUTHOR CONTRIBUTIONS
Lingyi Zhao and Yao Ni:
Writing-original draft; writing-review & editing.
Jingying Sun: Data collection.
Janzhou Ye: Supervision.
Lingyi Zhao and Yao Ni contributed equally to this work
CONFLICT OF INTEREST STATEMENT
The authors declare no conflict of interest.
DATA AVAILABILITY STATEMENT
Data sharing is not applicable to this article as no datasets were
generated or analyzed during the current study. Data sharing does not
apply to this article as no new data were created or analyzed in this
study.
ETHICS STATEMENT
The patient has consented to publish this information.