Rounded atrophic areas on the dorsum of the tongue: plaques en prairie fauchée of secondary syphilis

摘要

A 22-year-old male patient presented with a three-week history of initially asymptomatic lesions on the dorsum of the tongue that progressed to dysgeusia (distortion of taste), a burning tongue (especially with hot and spicy foods), and mild dysphagia. The patient had a diagnosis of HIV infection made 30 months earlier but was antiretroviral naive. Primary syphilis had been diagnosed and treated 23 months previously. On clinical examination, there was cervical lymphadenopathy and several shallow, round to oval atrophic and erythematous erosions of the posterior aspect of the tongue, with loss of papillae (Fig. 1). There were no cutaneous lesions and physical examination was otherwise unremarkable. The CD4 cell count was 576 cells/j1 and the plasma HIV viral load was 1181 copies (3.072 log)/jl. New serological assays yielded a Veneral Disease Research Laboratory (VDRL) titer of 1/512. Three consecutive weekly administrations of 2.4 million units of intramuscular benzathine penicillin G were prescribed and highly active antiretroviral therapy was started with lamivudine, tenofovir, and dolutegravir. One month later a complete clinical remission was recorded. Two months later the VDRL titer had dropped to 1/32.