Ocular Syphilis Mimicking Giant Cell Arteritis

Area of Science:

• Ophthalmology
• Infectious Diseases
• Neurology

Background:

• Syphilis, caused by *Treponema pallidum*, is a rare but serious cause of vision loss.
• Ocular syphilis can affect any part of the eye and mimic autoimmune diseases like giant cell arteritis.
• Systemic dissemination of spirochetes leads to secondary and tertiary syphilis, with potential ocular manifestations.

Observation:

• A 59-year-old male presented with severe vision loss and headache, initially misdiagnosed as giant cell arteritis.
• A macular rash on palms and soles prompted the correct diagnosis of ocular syphilis.
• The patient was treated with penicillin G and probenecid.

Findings:

• Prompt treatment led to significant improvement in visual acuity and visual field.
• Ocular syphilis can present with varied symptoms including scleritis, optic nerve inflammation, and uveitis.
• Delayed diagnosis or misdiagnosis of ocular syphilis can result in irreversible vision loss.

Implications:

• Physicians must consider ocular syphilis in patients with sudden vision loss and severe headaches.
• Increased awareness and timely diagnosis are essential to prevent permanent vision impairment.
• This case highlights the importance of recognizing diverse presentations of syphilis for effective patient management.