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Case Reports in Emergency Medicine
Volume 2016, Article ID 1607583, 3 pages
Case Report

The Great Imitator Strikes Again: Syphilis Presenting as “Tongue Changing Colors”

University of Texas Dell School of Medicine, Austin, TX 78701, USA

Received 17 November 2015; Accepted 29 December 2015

Academic Editor: Serdar Kula

Copyright © 2016 Jessica Swanson and Janna Welch. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Syphilis is known as the great imitator, making its diagnosis in the emergency department difficult. A 29-year-old male presented with the chief complaint of “my tongue is changing colors.” A syphilis rapid plasma reagin (RPR) test resulted as positive. In primary syphilis, the chancre is the characteristic lesion. While chancres are frequently found on the external genitalia or anus, extragenital chancres arise in 2% of patients. With oral involvement, the chancre is commonly found on the lip or tongue. The patient was treated for secondary syphilis with 2.4 million units of long acting penicillin intramuscularly. On follow-up a month later, the patient’s symptoms had resolved.