Hypophysitis in a HIV-Positive Patient With a Syphilis Latent Infection

Area of Science:

• Endocrinology
• Infectious Diseases
• Neurology

Background:

• Hypophysitis is a rare pituitary gland inflammation, often autoimmune but can be secondary to infections.
• In HIV-positive individuals, coinfection with *Treponema pallidum* (syphilis) can trigger hypophysitis.
• This can lead to panhypopituitarism, visual field defects, and neurological issues.

Purpose of the Study:

• To describe an uncommon case of syphilitic hypophysitis in an HIV-positive patient.
• To highlight the successful management of this condition with antibiotics and hormone replacement.

Main Methods:

• A case report of a 50-year-old male with HIV and latent syphilis presenting with neurological and visual symptoms.
• Diagnostic workup included RPR test, CD4 count, viral load, biochemical tests for panhypopituitarism, ophthalmologic assessment, and brain MRI.
• Treatment involved intravenous penicillin and hormone replacement therapy.

Main Results:

• The patient presented with headache, fatigue, and visual decline, diagnosed with panhypopituitarism and bitemporal hemianopia.
• Brain MRI revealed a sellar mass consistent with pituitary inflammation.
• Treatment led to reduced pituitary size, resolution of neurological symptoms, and improved vision.

Conclusions:

• Syphilitic hypophysitis is a rare but important consideration in HIV-infected patients with endocrine and visual abnormalities.
• Successful management involves prompt antibiotic treatment and hormonal support.
• Increased HIV-syphilis coinfection rates may lead to more frequent encounters with this condition.