A 19-year-old male presented for evaluation of painful lesions on the tongue that had been present for at least 3 months. He stated that the pain was exacerbated by spicy foods. He had initially presented to a primary care practitioner, was prescribed clotrimazole lozenges, and reported mild initial improvement followed by symptom progression. Subsequently, the practitioner referred the patient to an otolaryngologist.
The patient denied any enlarged lymph nodes, fevers, fatigue, rash, weight loss, or abnormal gastrointestinal symptoms and had no noteworthy medical history. He reported mild alcohol consumption, denied any cigarette or illicit substance use, and endorsed engaging in oral and anal intercourse.
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C. Secondary syphilis
Leukoplakia in young patients is rare1; however, it has been noted that oral squamous cell carcinoma in young patients (<40 years old) should not be missed because it is associated with aggressive disease.2 The differential diagnosis for this patient’s tongue lesions included squamous cell carcinoma,3 hyperkeratotic dysplasia, lichen planus, hairy leukoplakia, and infectious causes, eg, candidiasis, HIV, and oral syphilis. Although nonspecific, the dense plasmacytic infiltrate seen on hematoxylin-eosin staining is a characteristic histopathologic finding of mucocutaneous syphilis (Figure 1B).4,5 Of note, the inflammatory cells were morphologically typical, making neoplastic causes in the differential diagnosis unlikely.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Theresa Guo, MD, Department of Otolaryngology–Head & Neck Surgery, University of California San Diego School of Medicine, 3855 Health Sciences Dr, MCC 2331, La Jolla, CA 92037 (email@example.com).
Published Online: November 23, 2022. doi:10.1001/jamaoto.2022.3799
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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