The New England Journal of MedicineSyphilitic Pharyngitis

Unveiling the Uncommon: Syphilitic Pharyngitis and Its Underlying Connections

In a notable case of syphilitic pharyngitis, a 40-year-old man presented with persistent sore throat symptoms, leading to an unexpected diagnosis. This “Images in Medicine” case stresses the importance of considering a broad differential diagnosis in atypical presentations, revealing the intricate interplay between clinical symptoms and infectious etiologies. Highlighting the significance of thorough history-taking and the utility of specific diagnostic tests, this account provides valuable insights into the management and implications of this rare presentation of a well-known disease.

Key Points:

• A 40-year-old man sought medical attention for a month-long history of sore throat, devoid of typical upper respiratory or syphilitic symptoms.
• Physical examination revealed distinctive nonulcerated white plaques forming a butterfly pattern across the posterior oropharynx, upper uvula, and tonsils.
• Initial bacterial throat culture yielded only normal flora, while a biopsy indicated dense lymphoplasmacytic infiltration.
• Serological tests confirmed syphilis, with a significantly elevated rapid plasma reagin level and positive Treponema pallidum hemagglutination assay.
• The patient disclosed a recent history of unprotected sexual contact, providing a potential link to his current condition.
• Immunohistochemical staining on the biopsy specimen confirmed the presence of T. pallidum.
• Despite the typical treatment being benzathine penicillin G, the patient received amoxicillin due to local availability, resulting in symptom resolution.
• The case highlights the necessity of considering syphilis in the differential diagnosis of unusual oropharyngeal lesions, especially in patients with relevant risk factors.
• It underscores the importance of a comprehensive sexual history and awareness of atypical presentations of common infections.

Syphilis, a disease known for its chameleon-like manifestations, has been on the rise globally, with a reported increase of more than 70% in new cases over the past decade, with 7.1 million adults between 15 and 49 years old acquiring the condition in 2020, according to the WHO.

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