Tertiary Syphilis Lesion External Auditory Canal: A Case Report

Introduction: Syphilis is an infectious disease caused by Treponema pallidum. The primary syphilis is characterized by the appearance of the chancre at the site of inoculation 3 weeks after infection. Staying for a period of latency after 6 to 8 weeks, progress to secondary syphilis, where there is a hematological dissemination of spirochetes and impaired epithelial surface and internal organs. After 1 to 10 years of evolution, one can develop tertiary syphilis with destructive granulomas cutaneous lesions or “gums” that are usually alone or in small numbers and asymmetric with central healing and peripheral extension.

Objective: The study aimed to report a case of tertiary syphilis treated at the Regional Hospital in Presidente Prudente in January 2014.

Resumed Report: A 38-year-old male patient (P.C.A.), single, assistant storekeeper, was admitted to the neurosurgery service due to a sudden loss of visual field and bilateral papilledema with suspected neurosyphilis. On evaluation by an otolaryngologist, the patient complained of lesions in the left external auditory canal that began 3 months ago, as pruritic plaques evolving into ulcerative lesions, which regressed in the past month, but did not disappear completely and had relapsed. It was there for 5 days. Normal hearing or other previous diseases were noted. Pathological lesion showed keratotic papilloma. VDRL 1/32, FTA-ABS positive, others negative serology including anti-HIV. The patient was treated with crystalline penicillin.

Conclusion: Biopsy of the auricular lesion was suggestive of keratotic papilloma; however, in lesions in the “gum”, the characteristics of tertiary syphilis, with no presence of treponemes, were observed, which could explain the injury to be “clean” at the time of examination.