Diagnostic and Therapeutic Approaches for a Diabetic Patient Presenting with Secondary Syphilis and Severe Odynophagia

Abstract

Syphilis, an infectious disease caused by the spirochete Treponema pallidum, represents a pervasive global epidemic. Secondary syphilis is typically marked by the emergence of highly contagious mucocutaneous manifestations, including non-pruritic rashes on the palms and soles of the feet, alopecia, mucous patches, and condyloma lata. Here, we report a rare case of a 30-year-old male with newly discovered type 2 diabetes mellitus who presented with severe odynophagia due to secondary syphilis, confirmed by both nontreponemal VDRL/RPR and treponemal TPHA tests. Following the administration of a single-dose intramuscular injection of benzathine penicillin G 2.4 million units, the symptoms gradually decreased, allowing the patient to regain his health.

Keywords: Treponema pallidum; diabetes mellitus; infectious disease; odynophagia; sexually transmitted infection; syphilis.

Figure 1

Initial clinical presentation at the Emergency Unit of Dr. Soetomo General Academic Hospital. (A) Swollen lips with crusts, accompanied by hypersalivation. Thick white plaques were observed throughout the oral cavity, notably on the hard and soft palate. (B) Multiple non-pruritic rashes are present on both hands. (C) A painless genital ulcer is located adjacent to the penile glans.

Figure 2

The physical appearance of the patient. No visible rashes or skin lesions were observed on the back of the body (A), trunk (B), and abdomen (B).

Figure 3

(A) Electrocardiographic data showing normal results and (B) chest X-ray indicating right hilar lymphadenopathy.

Figure 4

The physical appearance before discharge. (A) The edema on the lower lip has significantly reduced, and the blepharoconjunctivitis has been resolved. (B) The palmar rashes were still present at the point of discharge.

Figure 5

The timeline of disease and treatment progression. This timeline displays the key clinical, laboratory, and microbiological findings during the in-hospital treatment of the patient.

Figure 6

The algorithm for syphilis diagnosis and treatment according to the American Academy of Family Physicians (AAFP) (CSF = cerebrospinal fluid; HIV = human immunodeficiency virus; IM = intramuscular; IV = intravenous) [11].

Figure 7

The follow-up algorithm for patients with primary or secondary syphilis is based on the American Academy of Family Physicians (AAFP) guidelines. [11].