# Syphilitic gumma presenting as squamous cell carcinoma of Vulva: A case report

## TL;DR

A case of syphilis mistaken for vulvar cancer highlights the disease's ability to mimic other conditions and the need for thorough diagnosis.

## Contribution

This is the first comprehensive case report of vulvar cutaneous syphilis masquerading as squamous cell carcinoma.

## Key findings

- Tertiary syphilis can present as a painful, rapidly-growing vulvar lesion resembling squamous cell carcinoma.
- Delayed diagnosis occurred due to atypical presentation and lack of access to care.
- The case emphasizes the importance of sexual history and gynecologic care in post-menopausal and rural populations.

## Abstract

•Syphilis, also known as the “Great Imitator,” has historically been misdiagnosed as other diseases.•In modern times, tertiary syphilis is rarely seen, which can lead to diagnostic confusion.•Tertiary syphilis may present in ways not consistent with traditional descriptions of the disease.•Tertiary cutaneous syphilis can masquerade as a painful, rapidly-growing squamous cell carcinoma of the vulva.•Rising rates of primary symphilis emphasize the importance of characterizing atypical presentations of tertiary syphilis.

Syphilis, also known as the “Great Imitator,” has historically been misdiagnosed as other diseases.

In modern times, tertiary syphilis is rarely seen, which can lead to diagnostic confusion.

Tertiary syphilis may present in ways not consistent with traditional descriptions of the disease.

Tertiary cutaneous syphilis can masquerade as a painful, rapidly-growing squamous cell carcinoma of the vulva.

Rising rates of primary symphilis emphasize the importance of characterizing atypical presentations of tertiary syphilis.

Tertiary syphilis, a late form of the disease with neurologic, cutaneous, and cardiovascular manifestations, is rarely seen in the United States in modern times. Also called the “great imitator,” syphilis tends to mimic other disease processes, which can lead to a delay in proper diagnosis and treatment.

We present the case of a 59-year-old woman who presented for evaluation of possible squamous cell carcinoma of the vulva. After multiple inconclusive biopsies and extensive workup with multiple providers, she was instead found to have cutaneous and neurologic tertiary syphilis. A correct diagnosis was delayed in this patient due to a presentation not consistent with classical teachings and due to a lack of access to care.

Syphilis has characteristic signs and symptoms, but in practice, it can have an indolent presentation that may differ from traditional presentations. To our knowledge, this is the first comprehensive case report of vulvar cutaneous syphilis masquerading as squamous cell carcinoma of the vulva. This case also provides additional evidence for the necessity of comprehensive gynecologic care and sexual history-taking in the post-menopausal populations and in rural communities.