A rare case of tertiary nasal syphilis: an unusual ear, nose, and throat manifestation of a rare disease

Abstract

Tertiary syphilis is a rare entity in present antibiotic era. Syphilis of the nose is considered to be very rare by all authorities. It is mainly a systemic disease caused by the spirochete Treponema pallidum. The infection acquired may be congenital or acquired. Tertiary syphilis shows most marked manifestations in nose, causing superficial and deep ulcerations, and gumma. Nasal septum, especially the junction of the cartilaginous with the bony septum resulting in perforation is a usual manifestation. In cases where the bony septum is involved, existence of syphilis is unquestionable. The nasal deformity results from destruction of bony framework of nose and shrinking of fibroid tissue, thus, produces the typical saddle nose which is characteristic of syphilis. The treatment line for syphilis has remained relatively unchanged in recent years and continues to vary with stage of infection. However, local treatment consists of clearance of crusts and regular cleansing of the nasal passages by copious alkaline douches. Yellow mercury oxide ointment may be applied locally. The purpose of local treatment is to remove the discharge and crusts, kill spirochetes, promote wound healing and epithelial growth, prevent secondary infection.