Syphilitic Tonsillitis: A Case Report and Review of the Literature.

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.