title: A rare case of a chronic syphilitic gumma in a man infected with human immunodeficiency virus.
abstract: OBJECTIVE
  This paper reports a rare case of a human immunodeficiency virus infected man with gummatous syphilis of the face.
  
  
  METHODS
  A 39-year-old man presented with an ulcer of the face which had been slowly progressive over the previous 6 years. Examination showed an ulcerative lesion of the midface involving the cheeks, and completely destroying the nose, the upper lip and part of the lower lip. The teeth and gums were exposed. The ulcer had a moist, purulent base with rolled edges. The patient had human immunodeficiency virus, with a cluster of differentiation 4 count of 641 cells per µl. The rapid plasma reagin test titre was 1:1024 and the Treponema pallidum haemagglutination assay result was positive. Biopsy showed non-necrotising granulomata with a negative Warthin-Starry silver stain. There was a dramatic response to treatment with penicillin.
  
  
  CONCLUSIONS
  This case study is a reminder that syphilis needs to be considered in the differential diagnosis of unusual presentations involving skin and bone.
authors.affiliation: Ear, Nose and Throat Department/Head and Neck Surgery,Chris Hani Baragwanath Hospital and University of the Witwatersrand,Soweto, Johannesburg,South Africa.
authors.forename: S D
authors.initials: SD
authors.lastname: Masege
authors.affiliation: Department of Medicine (Division of Infectious Diseases),Chris Hani Baragwanath Hospital and University of the Witwatersrand,Soweto, Johannesburg,South Africa.
authors.forename: A
authors.initials: A
authors.lastname: Karstaedt
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications*; D000328:Adult; D002908:Chronic Disease; D006801:Humans; D008297:Male; D009668:Nose Diseases / Q000150:complications*; D009057:Stomatognathic Diseases / Q000150:complications*; D013587:Syphilis / Q000150:complications*; D014210:Treponema pallidum