Syphilis Tertiaria -- Syphilis ulcerosa nasi

Syphilitic ulceration of the nose is a not uncommon late tertiary manifestation. It is the sequel of either diffuse or distinct gummatous infiltration, though the latter is much more rare than the former. It is unusual to see either lesion before ulceration has occured, probably because being painless and starting frequently on the inner wall of the nasal cavity, the process does not attract attention until ulceration supervenes. Gummas of the external nose prefer the nostril flaps and septum.

Beginning in the submucous or subcutaneous tissue, they spread and involve cartilage and bone, and unless promptly and energetically treated cause marked permanent deformity. In the case of a diffuse infiltration, the gumma extends rapidly, and after inflaming the cartilage and skin around the bone, interferes with the circulation to such an extent that necrosis ensues comparatively early. The slough often appears to extend wide of the original infiltration. When the ulceration is deep and the bone has become involved, the nasal discharge is frequently extremely offensive.

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