OBJECTIVE: To report the case of a patient with secondary syphilis presenting with oral lesions at the otorhinolaryngology clinic of the Hospital Geral da Santa Casa da Misericórdia do Rio de Janeiro. CASE REPORT: A 32-year-old, male patient came to our otorhinolaryngology clinic with persistent odynophagia for over a month. He had been diagnosed earlier with herpetic stomatitis and had received treatment with 2 courses of Acyclovir 200 mg, 5 times a day, for 7 days, along with Prednisone 20 mg per day for 5 days, with no relief. Otorhinolaryngologic examination showed involvement of the oropharynx with several flat and hyperemic ulcers that had white and serpiginous margins, and were suggestive of syphilis. Leading questions elicited the history of a small genital lesion that had disappeared spontaneously; in addition, physical examination revealed small, scaly and non-pruritic lesions on his back and chest. The non-treponemal VDRL test was reactive in a titer of 1:256 and the treponemal TPHA test. The patient was treated with 2 doses of Benzathine Penicillin 1.2 million units by the IM route; this resulted in a complete clinical response. The patient was followed up with the VDRL test repeated every 3 months; the titer came down to 1:2 by the end of 12 months. CONCLUSION: Syphilis is often encountered in otorhinolaryngologic practice; therefore, it is necessary to recognize its cutaneous and mucosal manifestations in the interests of early diagnosis that can enable the prompt institution of effective treatment to minimize sequelae.
