10.5826/dpc.1304a210
text/xml
2160-9381
3290
en
Yolanda Gilaberte
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
“Snail-Track Ulcers” And Macroglossia Due to Secondary Syphilis
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-10-31
2023-02-27
2023-10-31
2024-01-15
e2023210
Dermatol Pract Concept
Yolanda Gilaberte
2023/10/31
10.5826/dpc.1304a210
e2023210
Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Zaragoza, Spain
2160-9381
en
e2023210
de Oliveira Alves A, Filho FB. Snail track ulcers of the tongue. Pan Afr Med J. 2018 May 15;30:23. doi: 10.11604/pamj.2018.30.23.14118. PMID: 30167051; PMCID: PMC6110555.
“Snail-Track Ulcers” And Macroglossia Due to Secondary Syphilis
https://dpcj.org/index.php/dpc/article/download/3290/2389
                  “Snail-Track Ulcers” And Macroglossia
                        Due to Secondary Syphilis
                    Alba Navarro-Bielsa1, Tamara Gracia-Cazaña1, Yolanda Gilaberte1


1 Department of Dermatology, Miguel Servet University Hospital, IIS Aragón, Zaragoza, Spain



Citation: Navarro-Bielsa A, Gracia-Cazaña T, Gilaberte Y. “Snail-Track Ulcers” And Macroglossia Due To Secondary Syphilis. Dermatol
Pract Concept. 2023;13(4):e2023210. DOI: https://doi.org/10.5826/dpc.1304a210
Accepted: March 18, 2023; Published: October 2023
Copyright: ©2023 Navarro-Bielsa et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Alba Navarro-Bielsa, Department of Dermatology, Hospital Miguel Servet, Paseo Isabel la Católica, 1-3,
Zaragoza 50009, Spain. Telephone: (+34) 976 76 55 00 E-mail: albanavarrobielsa@hotmail.com




Case Presentation                                                        Teaching Point
A 36-year-old woman was referred to the Dermatology                      Oral lesions are presented in at least 30% of patients with
department for painful ulcers on the tongue and macro-                   secondary syphilis, although oral ulceration is rarely pre-
glossia (Figure 1A). Oral findings showed scattered depa-                sented as the only manifestation of infection [1]. The most
pilation and moist ulcers, irregular linear erosions termed              common oral features of secondary syphilis are mucous
‘snail-track’ ulcers on the dorsum of the tongue and the                 patches and maculopapular lesions [1,2].
left margin.                                                                  The oral features of secondary syphilis can be painless or
    A PCR was performed for viruses and bacterias and the                painful erythematous lesions, grayish-white mucous patches
diagnosis of secondary syphilis was reached by a positive                or, less frequently, irregular linear erosions (snail track
Treponema pallidum PCR on a tongue swab and a positive                   ­ulcers) [2]. We describe a case diagnosed of syphilis with
syphilis serology (RPR and TPPA test). The lesions com-                  ­significant involvement of the tongue with snail-track ulcers,
pletely resolve with benzathine penicillin G 2.4 million units           which are not common but could be a diagnostic clue, which
treatment in one month (Figure 1B).                                      evidence the need for considering syphilis in the differential
                                                                         diagnosis of oral ulcerations.




Image Letter | Dermatol Pract Concept. 2023;13(4):e2023210                                                                               1
                    Figure 1. (A) Clinical image of the tongue before the treatment, with “snail-track ulcers”, d
                                                                                                                ­ epapilation
                    and macroglossia. (B) Clinical image of the tongue 1 month after the treatment, with resolution of
                    the lesions.



References                                                               2. de Oliveira Alves A, Filho FB. Snail track ulcers of the tongue. Pan
                                                                            Afr Med J. 2018;30:23. DOI: 10.11604/pamj.2018.30.23.14118.
1. de Andrade RS, de Freitas EM, Rocha BA, Gusmão ES,                       PMID: 30167051. PMCID: PMC6110555.
   Filho MR, Júnior HM. Oral findings in secondary syphilis. Med
   Oral Patol Oral Cir Bucal. 2018;23(2):e138-e143. DOI: 10.4317
   /medoral.22196. PMID: 29476680. PMCID: PMC5911365.




2                                                                               Image Letter | Dermatol Pract Concept. 2023;13(4):e2023210
