Intractable Stomatitis Accompanied with Cervical Lymphadenopathy: An Unusual Manifestation of Secondary Syphilis

以頑固性口炎合備全頸部淋巴腫大為表現之罕見二級梅毒

吳金珠(Chin-Chu Wu) ； 鄭博文(Po-Wen Cheng) ； 黃琮瑋(Tsung-Wei Huang)

《台灣耳鼻喉頭頸外科雜誌》 50卷1期 (2015/03) Pp. 58-62

https://doi.org/10.6286/2015.50.1.58

摘要

頑固性口炎是臨床醫師的一大挑戰，因為很多疾病可能會侵犯腔及口咽黏膜。我們報告1名以難治癒性口腔炎合併頸部淋巴腫大為表現的二級梅毒患者。患者為30歲男性患有白色廣泛性口咽病症超過3個月之久，理學檢查顯示在軟腭、懸雍垂及前舌腭弓位置有廣泛性白色斑塊分佈於紅色增厚組織上，頸部並有多顆淋巴結腫大，患者身體並無他處有皮膚黏膜異常。口腔及頸部腫塊病理切片則顯示漿細胞與血管外淋巴球浸潤，並有血管閉鎖現象。然而Warthin-Starry染色卻無發現任何微生物，而進一步針對梅毒螺旋體之免疫染色則顯示出螺旋菌體，而梅毒血清檢測也則均為陽生，因此診斷為二級梅毒。於是患者接受青黴素肌肉注射治療，1週後，口咽及頸部淋巴腫大均消失。故我們建議臨床上對於難治癒性口腔炎，即使生殖器官並無徵狀，仍應懷疑二級梅毒感染的可能，並進一步以免疫組織染色合併血清檢測診斷。

關鍵字

梅毒 ； 口腔炎 ； 頸部淋巴腺腫

並列摘要

Intractable stomatitis remains a diagnostic challenge for clinicians since many disease entities involve oral and oropharyngeal mucosa. Isolated oropharyngeal lesion without general manifestations as a consequence of syphilis is rare. We report a case of intractable oropharyngeal ulcer combined with cervical lymphadenopathy as the presentation of secondary syphilis. A 30-year-old male presented with a whitish and painless oropharyngeal lesion for more than three months. Physical examination showed extensive, smooth and white plaques on an erythematous base involving the soft palate, uvula, and anterior pillars. Multiple lymph nodes, up to 3 cm in diameter, were also palpable at the upper neck. Pathological examinations of oropharyngeal lesion and lymph node displayed a mixed cellular infiltrate with plasma cells, a perivascular lymphocytic infiltrate, and obliteration of the vessels. However, a Warthin-Starry stain failed to demonstrate any microorganisms. Immunohistochemistry for detection of ＂Treponema pallidum＂ revealed microorganisms in biopsy samples. The results of VDRL and TPHA serum test were positive. Secondary syphilis was then diagnosed, although the patient had no lesions on the genital organ or oral cavity early on. He was treated with intramuscular benzathine penicillin with full resolution of the oropharyngeal lesion and neck nodes within one week. We suggest that secondary syphilis should be considered while treating intractable isolated oropharyngeal lesion without general manifestations. Serological tests and immunohistochemistry of biopsy samples are helpful for these patients.

並列關鍵字

syphilis ； stomatitis ； cervical lymphadenopathy