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| Figure 1 |
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| Exuberant, numerous white plaques on the mucosal aspects of upper and lower lips. |
A young lady farmer presented with a 3-month history of slightly sore progressive lesions in the oral cavity. There was no history of similar lesions, genital ulcers, generalised skin eruptions, or systemic complaints, except for episodic knee and elbow pains. She was healthy in the past and had monogamous sexual relationship.
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| Figure 2 | Figure 3 |
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| Complete resolution of the lesions on upper and lower lips respectively following a single dose of Benzathine penicillin after 10 days. | |
There were multiple, white exuberant plaques on the mucosal aspects of lips and cheeks bilaterally (Fig. 1). There was no regional lymphadenopathy. Genital, systemic, and general examinations were otherwise normal. Two small epitrochlear lymph nodes were palpable. All her investigations including complete blood count, urinalysis, blood sugar, HIV, uric acid, rheumatoid factor, and collagen profile were normal. However, her VDRL test showed a positive titre of 1:64. Single intramuscular injection of Benzathine Penicillin 2.4 megaunits resulted in rapid resolution of all her lesions (Figs. 2 and 3).
Mucous patches are a classic manifestation of secondary syphilis, but it is very rare to find them as the only objective clinical sign of active disease. The diagnosis could be deceptive for those who do not suspect the disease. This case illustrates the impact of visual diagnosis in dermatology.
© 2005 Dermatology Online Journal