Diagnostic riddle- case report of ocular syphilis

Area of Science:

• Ophthalmology
• Infectious Diseases
• Public Health

Background:

• Syphilis (Treponema pallidum infection) is a sexually transmitted infection (STI) with rising incidence.
• Ocular syphilis cases are becoming more frequent, posing diagnostic challenges in ophthalmology.

Purpose of the Study:

• To highlight the importance of considering syphilis in the differential diagnosis of atypical ocular conditions.
• To present a case of ocular syphilis with unusual presentation and co-infection.

Main Methods:

• Case report of a 29-year-old male with blurred vision and anterior uveitis.
• Diagnostic workup including ophthalmological examination, B-scan ultrasound, and laboratory tests for syphilis and HIV.
• Treatment with intravenous penicillin and antiretroviral drugs.

Main Results:

• Initial misdiagnosis as herpetic infection due to atypical presentation.
• Development of iris lesions and rash led to syphilis and HIV co-infection confirmation.
• Successful treatment with penicillin resulted in complete visual recovery (BCVA 20/20) within 6 months.

Conclusions:

• Ocular syphilis can mimic other conditions, necessitating a high index of suspicion.
• Testing for STIs, particularly Treponema pallidum, is crucial for non-responsive or atypical ocular symptoms.
• Prompt diagnosis and treatment of ocular syphilis, especially in co-infected patients, lead to favorable visual outcomes.