Sífilis secundaria en un paciente VIH positivo

La incidencia de afecciones orales, antes infrecuentes en pacientes infectados por VIH, se está incrementando y es posible que se subestime. Las lesiones orales resultantes de la sífilis secundaria son raras; sin embargo, ocurren, y el odontólogo debería ser capaz de realizar un correcto diagnóstico. En algunos casos la anámnesis y los signos clínicos de las lesiones son insuficientes para permitir el diagnóstico de la enfermedad. El conocimiento de sus características histológicas y las pruebas de laboratorio relevantes, así como su aplicabilidad y limitaciones son necesarios para el correcto diagnóstico de la sífilis secundaria.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's 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