Syphilitic Gumma Misdiagnosed Midline Granuloma

Introduction  Ulcers of the face and lips are not uncommon problems. When they are proliferative in nature, they present complicated problems for the clinician charged with establishing the diagnosis and executing proper therapy. The differential diagnosis is interesting, and the case presented here allows one the opportunity to speculate on many rare and unusual diagnostic possibilities.

Report of a Case  A 57-year-old white coal miner was admitted to the Pittsburgh Veterans Administration Hospital in March, 1963, for evaluation of a dark crusted ulcerative lesion of the upper lip. He stated that about 18 months prior to admission he had developed a small sore under his nose which bled when traumatized. This lesion had never healed; rather it had slowly enlarged until the time of admission. Other than esthetically, the lesion did not bother him and was not associated with pain. He complained of "sinusitis" for a number of years but