Tonsillar chancre as unusual manifestation of primary syphilis

Abstract

Primary syphilis with oropharyngeal manifestations should be kept in mind, though. Lips and tongue ulcers are the most frequently reported lesions and tonsillar ulcers are much more rare. We report the case of a 24-year-old woman with a syphilitic ulcer localized in her left tonsil.

Unilateral tonsillitis due to primary syphilis with gram-negative corkscrew-like spirochaetes confirmed by Gram stain of pus

“…Previous case reports of syphilitic tonsillitis published in English are summarised in table 1 4–10 15–22. Laterality of tonsil and cervical lymphadenopathy are not useful in distinguishing between primary and secondary syphilis (online supplemental table 1).…”

Not your usual tonsillitis: a lesson for recognizing primary tonsillar syphilis

“…Although oropharyngeal involvement is more frequently a manifestation of secondary syphilis that includes diffuse rashes involving the skin and mucosal surfaces, increases in oro‐genital sex practices, including in men who have sex with men (MSM), have led to an increase in primary oropharyngeal involvement. Still, there have only been a few case reports of tonsillar syphilis with tonsillar ulceration as the sole manifestation and only one report with documented histologic changes, likely due to underdiagnosis 2–4 . Lesions of reported primary tonsillar syphilis can present with swelling and redness with an ulcerated surface, but, similar to the chancre of primary genital syphilis, are otherwise typically painless and therefore likely to go unnoticed.…”

“…Still, there have only been a few case reports of tonsillar syphilis with tonsillar ulceration as the sole manifestation and only one report with documented histologic changes, likely due to underdiagnosis. [2][3][4] Lesions of reported primary tonsillar syphilis can present with swelling and redness with an ulcerated surface, but, similar to the chancre of primary genital syphilis, are otherwise typically painless and therefore likely to go unnoticed. Histologic changes of syphilis involving the aerodigetsive tract are generally nonspecific and varied and include epidermal hyperplasia, lymphocytic perivascular infiltration with plasma cells, and reactive follicular hyperplasia.…”