Syphilitic tonsillitis presenting as an ulcerated tonsillar tumor with ipsilateral lymphadenopathy

We describe a 49-year-old man who presented with a cervical mass of a week's evolution, which clinically mimicked a tumoral expansion. Physical examination showed a left cervical mass of 6 × 4 × 2 cm, associated to a left ulcerated tonsillar tumor. The presumptive diagnosis was a tonsillar cancer with lymph node involvement. An amygdalectomy and a frozen section biopsy of the cervical tumor were performed. The biopsy displayed a reactive lymphadenopathy with follicular and interfollicular hyperplasia rich in plasma cells, epithelioid areas, and an outstanding parcel fibrosis of subcapsular, interfollicular, and perifollicular distribution associated to an isolated focus of polymorphonuclear leukocytes and obliterative parietal angiovascular proliferation. The tonsil presented a similar but ulcerated process. These results suggested an infectious reactive process, probably luetic. A Warthin-Starry stain revealed spirochetes in the tonsillar ulcer. Laboratory examinations revealed a positive VDRL test and negative serology for HIV. In conclusion, a primary syphilis of the oropharyngeal tonsil with a syphilic lymphadenopathy was diagnosed. The literature about tonsillar syphilis is reviewed.