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Case Reports
. 2024 Feb 17;17(2):e258549.
doi: 10.1136/bcr-2023-258549.

Unilateral tonsillitis due to primary syphilis with gram-negative corkscrew-like spirochaetes confirmed by Gram stain of pus

Tomohiro Taniguchi  1 , Mayu Yamamoto  2 , Sonoko Miyoshi  2 , Satomi Shimizu  3
Affiliations
Case Reports

Unilateral tonsillitis due to primary syphilis with gram-negative corkscrew-like spirochaetes confirmed by Gram stain of pus

Tomohiro Taniguchi et al. BMJ Case Rep. .

Abstract

A man in his 40s presented with pharyngeal pain and right cervical lymphadenopathy that persisted for 1 month. His right tonsil was swollen and covered with exudate; however, a rapid streptococcal antigen test was negative. Rapid plasma reagin and Treponema pallidum antibody were positive. Gram staining of the pus confirmed the presence of gram-negative corkscrew-like spirochaetes. The patient had unprotected oral intercourse. He did not have any skin lesions. He was diagnosed with primary syphilis and treated with benzathine penicillin G. In adults, the differential diagnosis of tonsillitis should include sexually transmitted diseases. A rapid streptococcal antigen test is not sufficient for such a case; a syphilis test is necessary, and Gram staining, which is rapid and does not need any special equipment, can support the diagnosis.

Keywords: Infectious diseases; Syphilis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Right tonsillitis (triangle) covered with pus.
Figure 2
Figure 2
(A–C) Gram-stained pus showing gram-negative corkscrew-like spirochaetes (double arrow) and leucocytes (triangle) (×1000).
See this image and copyright information in PMC

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