Perforation of the palate - A report of two Syphilitic Gumma cases

Abstract

Syphilis has recently shown resurgence in its incidence especially in immune-compromised patients. We present two cases of tertiary syphilis in middle-aged males with large perforations in the hard and soft palates, one of which had Human Immunodeficiency Virus (HIV) co-infection. Diagnosis was initially difficult due to non-specific features mimicking other conditions such as perforation of cocaine abuse aetiology, neoplastic conditions, sarcoi-dosis, fungal infections, bacterial infections other than Treponema pallidum and Wegeners granulomatosis. With special investigations including Anti-Treponema Immunohistochemistry and histology, however, a definitive diagnosis of syphilitic gumma was reached. Intravenous penicillin was the mainstay of management along with treatment of the underlying medical conditions. A removable acrylic obturator was used to close the oro-nasal fistula to improve swallowing and speech. Syphilis should be included as a differential diagnosis in cases of palatal perforation.