ORAL MANIFESTATION OF PRIMARY SYPHILIS IN PATIENT WITH LICHEN PLANUS – CASE REPORT
Zoran Nedić1, Zoran Golušin2,3, Miloš Nišavić2,3, Dragan Vemić4
1 General Hospital Pančevo, Dept. of Dermatovenereology, Pancevo, Serbia
2 Faculty of Medicine, University of Novi Sad, Serbia
3 Clinc of Dermatovenereology Diseases, Clinical Center of Vojvodina, Novi Sad, Serbia
4 General Hospital Vrbas, Dept. of Dermatovenereology , Vrbas, Serbia

Background: Syphilis is a chronic systemic infectious disease, known as the „great imitator“ in medicine. Presence of primary chancre in primary stage of syphilis isn't commonly noted in medical practice on other localizations of the skin and mucosa, unlike the most common genitoanal localisation. Extragenial localization of primary chancre is recorded in 5-14% of the infected – in 2/3 of the cases it is present on the tongue, buccal mucosa, oropharynx, upper and lower lip.
Methods: We present patient 23 years old, worker on Cruise ship with medical history of lichen planus on the buccal mucosa more than a year. In the time of the examination, ulceration in mouth was present for 12 days. One month before the examination, he has had unsafe sex. On the vestibular side of the lower lip, round indurated ulceration was present – 7 mm in diameter with clean base and slightly elevated edges. On the buccal mucosa in the region of premolar, white net of lines was present that formed lace-like pattern – the characteristic of lichen planus. 
Results: The syphilis serology (VDRL, TPHA) was strongly positive. Benzathine penicilin 2.4 mega units intramuscular was administered. After four weeks the ulceration on the lower lip totally epithelized, while the changes on the buccal mucosa were still the same. After three months the non-treponemal test (VDRL) was negative, while the treponemal (TPHA) was still positive.
Conclusion: Syphilis should be always considered as a possible cause of the changes in the oral cavity, especially when ulceration is present.