title: Conventional systemic treatments associated with therapeutic sites of local lesions of secondary syphilis in the oral cavity in patients with AIDS.
abstract: Patients with HIV infection may develop common diseases with atypical clinical features. HIV infection can change the classic clinical course of syphilis and increase the incidence of malignant syphilis. Malignant syphilis is a rare subtype of secondary syphilis that presents special clinical and histological features and has been associated with several processes characterized by variable degrees of immunosuppression. It is necessary to consider the possibility of this entity in the differential diagnoses in HIV-infected patients with cutaneous lesions. The dental surgeon (or oral surgeon) is vital to the medical team for promoting the health and improving the quality of life of syphilis patients. A patient with HIV infection was referred to us for complaints of a white patch on the tongue, stinging and burning sensation on the tongue, loss of taste, and dryness of the mouth. On clinical examination, the patient was found to have a tabetic gait (the Prussian soldier gait) associated with Charcot arthropathy. We also identified bilateral lesions with ulceration and exposure of the tissue that were tender, characterized by discrete necrosis. The treatment that was initiated at that time involved cleaning the area with gauze to remove all the white patches, followed by rinsing with bicarbonate in water (one teaspoon of baking soda dissolved in half a glass of water) four times a day. Additionally, fluconazole (100 mg/day for 7 days) was prescribed. We diagnosed secondary malignant syphilis of approximately 5 days duration. As an adjunctive therapy, we performed low-intensity laser treatment using a GaAsAl (gallium-aluminum arsenide) laser at 790 nm. With this treatment there was progressive resolution of the lesions.
authors: Center for Studies and Consultations in Special Patients (CEAP) and Graduate Studies and Research/Dental, Universidade Paulista, Brazil.
authors: Elcio Magdalena
authors: EM
authors: Giovani
authors: Edson Rodrigues
authors: ER
authors: de Paula Neto
authors: Bruno Caputo
authors: BC
authors: Vieira
authors: Daniela Miranda Richarte
authors: DM
authors: de Andrade
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology*; D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000188:drug therapy; D000370:Ageusia / Q000382:microbiology; D000935:Antifungal Agents / Q000627:therapeutic use; D002021:Buffers; D002054:Burning Mouth Syndrome / Q000188:drug therapy / Q000382:microbiology*; D002180:Candidiasis, Oral / Q000175:diagnosis; D003131:Combined Modality Therapy; D015725:Fluconazole / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host; D054023:Lasers, Semiconductor / Q000627:therapeutic use; D028022:Low-Level Light Therapy / Q000379:methods; D008297:Male; D009067:Mouthwashes / Q000627:therapeutic use; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D013587:Syphilis / Q000175:diagnosis* / Q000188:drug therapy; D013591:Syphilis, Cutaneous / Q000175:diagnosis; D014060:Tongue Diseases / Q000188:drug therapy / Q000382:microbiology*; D014987:Xerostomia / Q000382:microbiology; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D002021:Buffers; D009067:Mouthwashes; D017693:Sodium Bicarbonate; D015725:Fluconazole