Relapsing Intermediate Uveitis following Resolved Syphilitic Retinitis in an HIV-Positive Patient: A Case Report

Ocular syphilis has atypical presentation in immunocompromised individuals. We report a case of intermediate uveitis as a delayed immune-mediated relapse following the successful treatment of syphilitic retinitis in an HIV-positive individual.

A 30-year-old HIV-positive man presented with decreased vision in his left eye. Examination revealed left eye granulomatous anterior uveitis with vitritis, retinal vasculitis, and optic disc edema. The patient was diagnosed with syphilitic uveitis, reactive for rapid plasma reagin (RPR), and initiated on intravenous penicillin by the internist. Topical corticosteroids were initiated, and oral corticosteroids were added after 1 week. Over 2 months, the lesions resolved clinically with decreasing RPR titers. After 2 months of complete remission and tapering of therapy, the patient presented with renewed disc edema, macular edema, vitreous cells, and snowballs suggestive of intermediate uveitis. The RPR titers showed a decreasing pattern.

The patient responded well to oral corticosteroids, indicating a likely immune-mediated relapse rather than reinfection. This case highlights the need for continued surveillance, even after clinical resolution.