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Syphilitic Tonsillitis: A Case Report and Review of the Literature
Alexandros Ganaiem1,2, Aggeliki Grigoraki3, Kallirroi Spanou4
1Otolaryngology - Head and Neck Surgery, Athens General Hospital of Thoracic Diseases "Sotiria", Athens, GRC.
None:
Syphilitic tonsillitis is an uncommon manifestation of Treponema pallidum infection that may present with nonspecific oropharyngeal symptoms and mimic other infectious or neoplastic processes. We report a case of a 30-year-old man who presented with a two-month history of sore throat, dysphagia, low-grade fever, and hoarseness. Clinical examination revealed bilateral tonsillar hypertrophy with ulcerated papules and cervical lymphadenopathy. A tonsillectomy was performed due to poor treatment response. Histopathology showed mucosal ulceration with architectural effacement due to marked paracortical hyperplasia, accompanied by prominent plasma cell infiltration (CD138+), scattered giant cells, and small non-caseating epithelioid granulomas. Serologic testing confirmed the diagnosis of oropharyngeal syphilis. The patient was treated with a single dose of 2.4 million units of intramuscular benzathine penicillin G, resulting in marked clinical improvement and a significant decline in nontreponemal titers at follow-up. This case underscores the diagnostic challenge of syphilitic tonsillitis and highlights the importance of considering syphilis in patients with persistent oropharyngeal lesions to avoid disease progression and complications.
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