Syphilitic pharyngitis (from NEJM iamge challenge)
A 40-year-old man was referred to the otorhinolaryngology clinic with a 1-month history of a sore throat. He reported no upper respiratory symptoms, fever, rash, or genital lesions. The physical examination was notable for nonulcerated white plaques that formed a butterfly shape across the posterior oropharynx, upper uvula, and tonsils. No lymphadenopathy or skin or genital lesions were present. Testing for the human immunodeficiency virus was negative. A biopsy of the plaques showed dense lymphoplasmacytic infiltration. A Treponema pallidum hemagglutination assay was positive, and the rapid plasma reagin level was 122.4 U (reference range, 0 to 0.9). Subsequent immunohistochemical staining for T. pallidum performed on the biopsy specimen was positive. A diagnosis of syphilitic pharyngitis — a manifestation of secondary syphilis — was made.