Nasal neoplasia is a common problem encountered in otolaryngology clinics and usually requires only complete removal of the mass. Recently, I treated a patient with a special case of nasal vestibular neoplasm, which presented with a hemispherical neoplasm with a diameter of >0.5 cm and an irregular yellowish-white surface in the right nasal vestibule. On examination, the mass was slightly hard, with a keratinized surface and poor mobility, with a tendency to invade the nasal cartilage. With the diagnosis of nasal papilloma, surgery was prepared. A routine preoperative blood test revealed that the patient was positive for antibodies to syphilis spirochetes, which prompted the surgeon to consider the nature of the swelling. The following is a brief discussion of syphilis, a sexually transmitted disease. Syphilis is a chronic infectious disease caused by syphilis spirochetes, the course of the disease is slow, in the process of development can invade any organ and tissue of the human body, produce a variety of symptoms, but also can be latent for many years or even for life, the disease in recent years in our country has an increasing trend, mainly through sexual intercourse, but also by kissing, sharing eating utensils, damaged skin or mucous membrane, blood transfusion, breastfeeding and other transmission, pregnant women can be transmitted to the fetus through the placenta. In this case, the patient’s positive syphilis spirochete antibody and the nature of the swelling invading the cartilage reminded the doctor of nasal syphilis. The clinical manifestations of nasal syphilis: Stage I nasal syphilis is called hard chancre and is extremely rare. The site of onset is usually located in the external nose, nostrils and tip of the nose; in the nose, it appears in the skin of the nasal vestibule and the lower part of the nasal septum. The chancre presentation is similar to that of vulvar chancre. The lesions are locally congested and blistered, and the blisters soon break down to form hard, clean-bottomed ulcers with raised margins. The submandibular and preauricular lymph nodes are often enlarged, firm, smooth and mobile, but without pressure pain. It may be accompanied by fever and symptoms such as eye and headache on the affected side. Stage II nasal syphilis is part of a generalized rash with congestion of the nasal mucosa and persistent nasal congestion, called syphilitic rhinitis. The nasal septum is seen as a dark red well-defined rash, and in a few cases, the entire nasal mucosa is flushed. The skin of the nasal vestibule shows eczema-like changes with crusting and chapping, and the anterior nostril maculopapular syphilis rash is rounded and elevated, bright red or dark red, with a smooth, slightly scaly surface, and in some cases the epidermis peels and gradually forms ulcers. Stage III nasal syphilis is the destruction of cartilage and bone due to dendritic syphilis tumors, forming collapsed nose and septal perforation, and atrophy of the nasal mucosa after the syphilis tumor infiltration subsides. Congenital nasal syphilis occurs between the ages of 3 years and adolescence and can be associated with Hutchinson’s triad (labyrinthitis, interstitial keratitis and jagged teeth) and sensorineural deafness in addition to a collapsed nose. Stage III syphilis should be differentiated from nasal tuberculosis, nasal leprosy, nasal sclerosis or malignancy. Ancillary tests for syphilis diagnosis 1. Laboratory tests are the main basis for confirming the diagnosis of syphilis. (1) Syphilis spirochete dark field examination: take the secretion of the lesion area for direct microscopic observation. (2) Immunofluorescence antibody test: detect syphilis spirochetes in the secretion with fluorescence-labeled anti-syphilis spirochetes antibodies, observed under a fluorescent microscope. Those who stain are positive. (3) Non-syphilis spirochete serologic test: high sensitivity but low specificity, prone to false positives, commonly used as primary screening for syphilis. Including serum without heating reactive element test (USR test), this method is commonly used, but the sensitivity of Phase I syphilis is not high. (4) syphilis spirochete serologic test: detection of anti-spirochete antibodies in the serum with syphilis antigen. 2, biopsy Microscopic syphilis tissue by a large number of lymphocytes and plasma cells to form granulomas and endovascular inflammation. In stage I and II syphilis, marked edema of the intima of the vessel wall is seen, while stage III lesions show endothelial cell hyperplasia and lumen narrowing. Changes such as foreign body giant cells, Langham giant cells and caseous necrosis may also be seen. For diagnostic routine, it is important to take a detailed history and look for clues. Detailed specialist examination and systemic examination, if there are characteristic or suspicious changes, primary screening tests must be performed, and those who are positive must be further examined to confirm the diagnosis; those who are negative and suspicious must still be further laboratory screened and tissue examined. Back to the book. In this case, understanding the specificity of syphilis in terms of its complex and diverse systemic manifestations in humans, and taking into account the medical history, we considered that the patient’s current nasal vestibular swelling could not be excluded from association with syphilis and considered a possible nasal syphiloma. And according to the treatment strategy of syphilis, surgery is currently not the preferred treatment option. Usually, the treatment of nasal syphilis is as follows: 1. Repellent syphilis therapy is based on penicillin treatment, and those who are allergic to penicillin can be treated with arsenic-bismuth combination, etc. Treatment principles: the earlier the better, standardized medication, sufficient dose, sufficient course of treatment. Long-term follow-up is required after treatment. The source of infection or sexual partners need to be examined and treated. In addition to local treatment, systemic treatment should be carried out according to the syphilis stage in order to cure. 2, symptomatic treatment to clean the wound, keep local clean, for the scar caused by the deformity is feasible repair forming surgery. After communicating with the patient, the patient requested to be discharged from the hospital and was given regular treatment of syphilis repellent. The swelling in the nasal vestibule fell off when the medication was administered for three days. One month later, the patient came to our clinic for follow-up and the nasal vestibule neoplasm had completely fallen off and the skin of the nasal vestibule was smooth and normal. In this case, simple excision of the swelling may damage the nasal cartilage and lead to deformity, and it cannot achieve the purpose of radical treatment. Timely detection of the cause and treatment of the cause is the key to successful treatment and prevention of further development of the disease.