A CASE OF PHARYNGEAL SYPHILIS

Abstract

　Syphilis is a systemic chronic inflammatory disease caused by the bacterium Treponema pallidum. Patients with syphilis often visit urology and dermatology clinics with skin and pudendal lesions. We encountered a case of pharyngeal syphilis with only characteristic oropharyngeal lesions. The patient was a 30-year-old man with a 2-month history of sore throat and tongue pain. At his first consultation, milky white spots were observed on the palatine tonsils bilaterally and on the uvula, presenting a “butterfly appearance” characteristic of pharyngeal syphilis, and on the left margin of the tongue, along with erosive lesions on the mucosa of the lower lip. Biopsy of a milky white spot on the left margin of the tongue revealed band-shaped inflammatory cell infiltration under the mucosa in hematoxylin-eosin stained sections, and positive region in the epidermis in specific antibody immunostaining against syphilis revealed, so that the patient was diagnosed as having pharyngeal syphilis. Both the Treponema pallidum haemagglutination and rapid plasma reagin (RPR) tests were positive. Since a biopsy was performed, the patient was treated with amoxicillin 1500 mg/day for 3 days. One week later, the mucosal lesions in the oropharynx were no longer visible to the naked eye. The amoxicillin dose was then reduced to 750 mg/day and the lesions did not recur. The test value in the RPR test decreased to meet the criterion for cure criteria, and the treatment was completed at 27 weeks. Syphilis typically presents with skin and genital lesions, but some patients lack typical skin and genital lesions and might only have oropharyngeal lesions. This case report serves to underscore the need for physicians to bear in mind the possibility of syphilis when they see characteristic oropharyngeal lesions, even in the absence of typical skin and urogenital lesions.