Nasal syphilis

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Nasal syphilis

    • Nasal syphilis is of two types: acquired and congenital.
    • Acquired
      • Primary. It manifests as primary chancre of the vestibule of nose
      1. Secondary.
        1. It manifests as simple rhinitis with crusting and fissuring in the nasal vestibule.
        2. Diagnosis is suggested by the presence of mucous patches in the pharynx, skin rash, fever and generalised lymphadenitis.
      2. Tertiary.
        1. This is the stage in which nose is commonly involved
        2. Typical manifestation is the formation of a gumma on the nasal septum.
        3. Later, the septum is destroyed both in its bony and cartilaginous parts.
        4. Perforation may also appear in the hard palate.
        5. There is offensive nasal discharge with crusts
        6. Bony or cartilaginous sequestra may be seen
        7. Bridge of the nose collapses causing a saddle nose deformity
    • Congenital
      • Early form
        1. It is seen in the first 3 months of life
        2. manifests as "snuffles".
        3. Soon the nasal discharge becomes purulent.
        4. This is associated with fissuring and excoriation of the nasal vestibule and of the upper lip.
      • Late form.
        1. Usually manifests around puberty.
        2. Other stigmata of syphilis such as corneal opacities, deafness and Hutchinson’s teeth are also present.
        3. Diagnosis
        4. It is made on serological tests (VDRL) and biopsy of the tissue with special stains to demonstrate Trep. pallidum.
      • Treatment
        1. Penicillin is the drug of choice: benzathine penicillin 2.4 million unitsi.m. every week for 3 weeks with a total dose of 7.2 million units.
        2. Nasal crusts are removed by irrigation with alkaline solution.
        3. Bony and cartilaginous sequestra should also be removed.
      • Complications
          • Syphilis can lead to vestibular stenosis, perforations of nasal septum and hard palate, secondary atrophic rhinitis and saddle nose deformity.


      Syphilis: Affection of nasal bones due to syphilis
      Syphilis: Offensive and destructive ozena with thick yellow nasal discharge. © Pankaj Oudhia
      Syphilis: Throbbing and burning in nasal and frontal bone. © Pankaj Oudhia
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