Ortega Karem López, Rezende Nathalie Pepe Medeiros de, Watanuki Fernando, Araujo Ney Soares de, Magalhaes Marina H C G
Centro de Cuidado Odontológico Especial, Facultad de Odontología, Universidad de Sao Paulo, Instituto Emilio Ribas de Enfermedades Infecciosas, Sao Paulo, Brasil.
Med Oral. 2004 Jan-Feb;9(1):33-8.
The incidence of oral manifestations of HIV infection is changing markedly. Oral afflictions previously uncommon in HIV condition are now emerging in this scenario and may be underestimated. Clinical characteristics of some oral diseases could change in the presence of HIV/AIDS infection and health care professionals must be made aware of such changes. Oral lesions of secondary syphilis are rare, however they can occur and the dentist should be able to diagnose them. In some cases the anamnesis and the clinical features of the lesions are not enough to diagnose this disease. Histological features and an acute knowledge on laboratory exams, as well as its applicability and limitations are necessary to diagnose it. The present report describes a case of secondary syphilis in an HIV positive patient. The patient showed red spots in the torso of skin and abdomen. The spots were also present on the hands but the color was darker. The oral mucosa had several ulcers, with variable shapes, sometimes recovered by a white and resistant membrane. They were present in the buccal mucosa, palate, gingiva, tongue and labial mucosa. Those clinical manifestations appeared 6 months earlier. Exams were performed (VDRL, FTA-abs, direct fungal exams in the skin and oral mucosa and a biopsy in the oral mucosa) but the diagnose remained unclear. Clinical and laboratory features disagreed and postponed the final diagnosis and the treatment for more than 6 months.
HIV感染的口腔表现发生率正在显著变化。以前在HIV感染者中不常见的口腔疾病现在在这种情况下逐渐出现，且可能被低估。在HIV/AIDS感染的情况下，一些口腔疾病的临床特征可能会改变，医护人员必须了解这些变化。二期梅毒的口腔损害很少见，但仍可能发生，牙医应能够诊断。在某些情况下，病史和损害的临床特征不足以诊断该病。组织学特征以及对实验室检查的深入了解，以及其适用性和局限性对于诊断该病是必要的。本报告描述了一例HIV阳性患者的二期梅毒病例。患者躯干和腹部皮肤出现红斑。手部也有红斑，但颜色较深。口腔黏膜有多处溃疡，形状各异，有时有白色坚韧膜覆盖。溃疡出现在颊黏膜、腭部、牙龈、舌和唇黏膜。这些临床表现于6个月前出现。进行了相关检查（性病研究实验室试验、荧光螺旋体抗体吸收试验、皮肤和口腔黏膜直接真菌检查以及口腔黏膜活检），但诊断仍不明确。临床和实验室特征不一致，导致最终诊断和治疗推迟了6个多月。
