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

Hypophysitis is a rare inflammatory disorder of the pituitary gland that may result from primary autoimmune disease or secondary causes such as infection. In people living with HIV, coinfection with Treponema pallidum can precipitate pituitary inflammation, leading to panhypopituitarism, visual field compromise, and neurological symptoms.

Written informed consent was obtained from the patient, with all personal identifiers removed, in compliance with the CARE guidelines.

A 50-year-old man with known HIV infection and a history of latent syphilis presented to the emergency department with headache, asthenia, adynamia, and visual decline. Laboratory evaluation demonstrated a positive rapid plasma reagin (RPR) test at 1:64, a CD4 count of 391 cells/µL, a viral load of 40,000 copies/mL, and biochemical evidence of panhypopituitarism. Ophthalmologic assessment revealed bitemporal hemianopia. Brain MRI identified a sellar mass compressing the optic chiasm, consistent with an infiltrative pituitary process. The patient was treated with intravenous penicillin and hormone replacement therapy. A follow-up MRI showed a reduction in pituitary size, and 1 month later he reported a resolution of neurological symptoms and a marked improvement in visual acuity.

The present description illustrates an uncommon manifestation of syphilis-related hypophysitis in an HIV-positive individual, managed successfully with antibiotics and hormonal supplementation. Although rarely reported in literature, syphilitic hypophysitis should be considered in HIV-infected patients presenting with endocrine deficits and visual field abnormalities. With rising rates of HIV-syphilis coinfection, clinicians may encounter this entity more frequently than previously appreciated.