Author(s)
Isaac E. Schwartz, MD
Anil N. Shah, MD
Niels H. Olson, MD
Alexander E. Stewart, MD
Affiliation(s)
Naval Medical Center
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to thoroughly discuss the differential diagnosis for atypical tonsillar infections, compare chronic to acute tonsillar infections in an immunocompromised patient. Objectives: 1) To present a case of secondary syphilis presenting as unilateral tonsillar mass with neck mass; and 2) to discuss the differential diagnosis of unilateral tonsillar mass in an immunocompromised patient. Study Design: Case report. Methods: Case report. Results: A 27 year old man with recently diagnosed HIV presented with right 4+ tonsillar swelling, right cervical lymphadenopathy, and pain that was refractory to multiple antibiotics. In order to obtain tissue for diagnosis, tonsillectomy was performed, which was complicated by multiple severe postoperative hemorrhages. Due to skin findings at a return visit, further testing was performed yielding a diagnosis of secondary syphilis. Syphilis tonsillitis was confirmed by retroactive pathologic examination of the surgical specimen which showed spirochetes. Conclusions: Secondary syphilis is an extremely rarely described cause of tonsillitis or tonsil mass. We present a case of secondary syphilis presenting as extreme tonsillar swelling in an HIV positive patient. This report is intended to highlight the importance of syphilis - a disease that has nearly doubled in incidence in recent years - as an etiology of head and neck disease. It is also an opportunity to review the infectious and neoplastic causes of atypical head and neck masses.