Objective: This paper reports a rare case of a human immunodeficiency virus infected man with gummatous syphilis of the face.
Case report: A 39-year-old man presented with an ulcer of the face which had been slowly progressive over the previous 6 years. Examination showed an ulcerative lesion of the midface involving the cheeks, and completely destroying the nose, the upper lip and part of the lower lip. The teeth and gums were exposed. The ulcer had a moist, purulent base with rolled edges. The patient had human immunodeficiency virus, with a cluster of differentiation 4 count of 641 cells per µl. The rapid plasma reagin test titre was 1:1024 and the Treponema pallidum haemagglutination assay result was positive. Biopsy showed non-necrotising granulomata with a negative Warthin-Starry silver stain. There was a dramatic response to treatment with penicillin.
Conclusion: This case study is a reminder that syphilis needs to be considered in the differential diagnosis of unusual presentations involving skin and bone.