Painless tonsillopharyngitis – a rare differential diagnosis

Introduction:

Syphilis is a chronic sexually transmitted disease caused by Treponema pallidum. Lues is most commonly spread through sexual activity, solely from human to human. The signs and symptoms of Lues vary depending in which of the four stages it presents. The primary stage presents with a single chancre. Often a firm, painless ulceration is present concomitant with enlarged lymph nodes. The lesion, untreated, may persist for 4 – 6 weeks. Depending on the sexual activity the lesion can occur at the genitals or extragenital like lips, oral cavity or oropharynx.

Casuistics:

A 55 years old man presented with painless white, elevated lesions of palatal arch and tonsils. No other lesions especially at genitals were reported. To prove diagnosis and exclude malignoma a biopsy was taken and blood tests incl. HIV, Hep. B/C and syphilis were performed.

Results:

The histopathological results showed a high-grade chronic inflammation, immuno histopathological results verified plenty treponema pallidum. Blood tests for HIV and Hep. B/C was negative. The treponemal pallidum particle agglutination (TPPA) test showed a titer of 1: 40960 and the lipoid-antibody titer were 1: 16. This confirmed an active syphilis disease in the oropharynx.

Conclusion:

This case presentation should call attention to the differential diagnosis of a painless tonsillopharyngitis. The syphilitic primary lesion (stage I) could occur extragenital, for example in the oral cavity and the oropharynx. To prove diagnosis and exclude malignoma a biopsy as well as additional blood tests should always be performed.

Publication History

Publication Date:
12 June 2019 (online)